What interventions are required to reduce road traffic injuries in Africa? A scoping review of the literature

Whole genome-based characterization of extended-spectrum β-lactamase-producing Enterobacter cloacae from orthopedic patients and environment of a tertiary referral hospital in Tanzania

Objectives

We investigated the genomic epidemiology of extended-spectrum β-lactamase-producing Enterobacter cloacae (ESBL-Ec) isolates from patients and hospital environment to better understand their distribution to help devising effective strategies for infection prevention and control.

Methods

We screened ESBL-Ec at Bugando Medical Center (BMC) in Mwanza, Tanzania. Rectal swabs from orthopedic patients on admission and swabs from the neighboring inanimate environment were collected. Following microbial culture, DNA was extracted from pure ESBL-Ec, and whole-genome sequencing was done. Sequence typing (ST), plasmid replicons, drug resistance, and virulence genes were deciphered using the Rapid Microbial Analysis Pipeline (rMAP).

Results

We obtained 209 ESBL isolates, of which 15 (7.2 %) were ESBL-Ec [8 (53.3 %) from patients and 7 (46.7 %) from the environment]. Seven isolates were novel and eight were diverse, each with a unique ST. All isolates harbored two to five β-lactamase genes, with the predominance of bla CTX-M-15 (15/15), bla OXA-1 (14/15), bla TEM (14/15) and bla ACT (12/15). The most common non β-lactam drug resistance genes were aac(3)-IIa (14/15), aac(6')-Ib-cr (14/15), fosA (14/15), and qnrB1 (12/15), aph(3″)-Ib (10/15) and aph(6)-Id (10/15). Eleven different types of plasmid replicons were identified in 14/15 of the isolates, harboring one to five plasmids, with the most common plasmids being IncFII (11/15) and IncFIB (10/15). All isolates harbored the outer membrane protein (ompA), and curli protein (csg) was in 14/15 isolates.

Conclusion

Admitted orthopedic patients and the hospital environment act as a reservoir of ESBL-Ec with diverse STs and endowed with drug resistance and arsenals of virulence genes, calling for their routine screening on admission for mitigation of potential subsequent infections.

A qualitative study on apparent and latent contributing factors to driving errors in Iran

Road traffic crashes (RTCs) disproportionately impact low and middle-income countries (LMICs). Current interventions in LMICs primarily target road user behavior, neglecting systemic issues and casting drivers as mere contributors. Given Iran's unique cultural, financial, and social intricacies, this study aims to explore the latent causes of RTCs, prioritizing drivers' experiences and encompassing insights from various traffic system components. Applying a qualitative approach, data were collected through 46 semi-structured interviews with 38 participants, including drivers and experts from traffic-related organizations. Content analysis identified ten themes as contributing to driving errors. Direct factors included fatigue influenced by economic and occupational conditions, distraction from internal and external sources, reckless behaviors influenced by traffic culture and environment, and Inadequate driving skills due to training. Macro-scale challenges in road infrastructure, vehicle quality, education, and accident investigations were highlighted. The lack of a centralized traffic safety authority and a predominant focus on penalizing drivers overshadowed systemic issues. The study offers valuable insights into the complex interplay of factors contributing to driving errors in LMICs, advocating for a paradigm shift towards holistic, systemic interventions beyond individual driver behavior and challenging the conventional blame-centric view associated with driving errors.

Orthopaedic and trauma research in Tanzania: A scoping review

Tanzania is disproportionately burdened by musculoskeletal injuries as it faces unique challenges when dealing with trauma care. This scoping review aims to summarize and assess the current state of orthopaedic and trauma research in Tanzania. By identifying key themes, trends, and gaps in the literature, this review seeks to guide future research initiatives catered specifically to the needs of Tanzania's healthcare system. Utilizing the PRISMA-ScR protocol, OVID Medline, PubMed, and CINAHL databases were searched from inception to June 17, 2023, using keywords such as "Orthopaedics" "Trauma" and "Tanzania". One hundred and ninety-two eligible studies were included and the Arksey and O'Malley framework for scoping studies was followed. There was a notable growth of relevant publications from 2015 onward, with peaks in growth in the years 2019, 2021, and 2020. The studies employed diverse research methodologies, with cross-sectional (n = 41, 21%) and prospective studies (n = 39, 20%) being the most prevalent, and randomized-controlled trials being the least prevalent methodology, making up eight studies (4.2%). The most common study themes were trauma (n = 101, 52.6%), lower extremity (n = 31, 16%), and spine-related issues (n = 27, 14%). Only three studies looked at work-related injuries (1.6%). Road traffic injuries (RTIs) were the most common mechanism of trauma in 77.0% of the trauma focused studies. Fifty-three percent of the studies were conducted by a majority of Tanzanian authors. This scoping review highlights various trends in orthopaedic and trauma research in Tanzania, with a particular emphasis on road traffic-related injuries. Various gaps are explored, including a lack of research on work-related injuries and a paucity of experimental research. Our findings underline areas where future research is warranted. The future of orthopaedic and trauma care in Tanzania depends on the efforts and collaboration of both local and international stakeholders.

Factors influencing the road accidents in low and middle-income countries: a systematic literature review

This paper studies the main factors affecting road traffic accidents (RTAs) using a systematic review. The primary focus is on factors related to road characteristics and driver behaviours. This review also addresses the socioeconomic and demographic factors to provide a clear overview of which groups suffer the most from RTAs. Several factors were found to affect RTAs, notably road characteristics: highways, high-speed roads, unplanned intersections and two-way roads without dividers; driver behaviours: reckless/aggressive driving and riding, excessive speeding, unawareness of traffic laws, and not using safety equipment; and vehicle types: four and two-wheeled. This review found that male and economically productive people with less education were mostly associated with RTAs. In addition, for most of the low and middle-income countries analyzed, there is a lack of quality data relating to RTAs. Nevertheless, this review provides researchers and policy makers with a better understanding of road accidents for improving road safety.

The impact of road safety strategy and policy on admissions to a national rehabilitation hospital; a 5-year retrospective review and reflection on trauma data

BACKGROUND

Globally, road traffic collisions (RTCs) are a common cause of death and disability. Although many countries, including Ireland, have road safety and trauma strategies, the impact on rehabilitation services is unclear. This study explores how admissions with RTC related injuries to a rehabilitation facility has changed over 5 years and how they contrast to major trauma audit (MTA) serious injury data from the same timeframe.

METHODS

A retrospective review of healthcare records with data abstraction in accordance with best practice was performed. Fisher's exact test and binary logistic regression were used to determine associations and statistical process control was used to analyse variation. All patients discharged with an International Classification of Diseases (ICD) 10 coded diagnosis of Transport accidents from 2014 to 2018 were included. In addition, serious injury data was abstracted from MTA reports.

RESULTS

338 cases were identified. Of these, 173 did not meet the inclusion criteria (readmissions) and were excluded. The total number analyzed was 165. Of these, 121 (73%) were male and 44 (27%) were female and 115 (72%) were under 40 years of age. The majority [128 (78%)] had traumatic brain injuries (TBI), 33 (20%) had traumatic spinal cord injuries and 4 (2.4%) had traumatic amputation The numbers varied over the time period of the study but showed normal variation and not special cause variation which suggests no significant impact of policy in the time frame. There was a large discrepancy between the number of severe TBIs reported in the MTA reports and the numbers admitted with RTC related TBI to the National Rehabilitation University Hospital (NRH). This suggests there may be many people not accessing the specialist rehabilitation services they require.

CONCLUSION

Data linkage between administrative and health datasets does not currently exist but offers huge potential for understanding the trauma and rehabilitation ecosystem in detail. This is required to better understand the impact of strategy and policy.

Out-of-pocket cost for medical care of injured patients presenting to emergency department of national hospital in Tanzania: a prospective cohort study

OBJECTIVE

We aimed to determine the out-of-pocket (OOP) costs for medical care of injured patients and the proportion of patients encountering catastrophic costs.

DESIGN

Prospective cohort study SETTING: Emergency department (ED) of a tertiary-level hospital in Dar es Salaam, Tanzania.

PARTICIPANTS

Injured adult patients seen at the ED of Muhimbili National Hospital from August 2019 to March 2020.

METHODS

During alternating 12-hour shifts, consecutive trauma patients were approached in the ED after stabilisation. A case report form was used to collect social-demographics and patient clinical profile. Total charges billed for ED and in-hospital care and OOP payments were obtained from the hospital billing system. Patients were interviewed by phone to determine the measures they took to pay their bills.

PRIMARY OUTCOME MEASURE

The primary outcome was the proportion of patients with catastrophic health expenditure (CHE), using the WHO definition of OOP expenditures ≥40% of monthly income.

RESULTS

We enrolled 355 trauma patients of whom 51 (14.4%) were insured. The median age was 32 years (IQR 25-40), 238 (83.2%) were male, 162 (56.6%) were married and 87.8% had ≥2 household dependents. The majority 224 (78.3%) had informal employment with a median monthly income of US$86. Overall, 286 (80.6%) had OOP expenses for their care. 95.1% of all patients had an Injury Severity Score <16 among whom OOP payments were US$176.98 (IQR 62.33-311.97). Chest injury and spinal injury incurred the highest OOP payments of US$282.63 (84.71-369.33) and 277.71 (191.02-874.47), respectively. Overall, 85.3% had a CHE. 203 patients (70.9%) were interviewed after discharge. In this group, 13.8% borrowed money from family, and 12.3% sold personal items of value to pay for their hospital bills.

CONCLUSION

OOP costs place a significant economic burden on individuals and families. Measures to reduce injury and financial risk are needed in Tanzania.

Risk reduction via spatial and temporal visualization of road accidents: a way forward for emergency response optimization in developing countries

To achieve an effective emergency response and road safety, this study aims to assist a semi-automated dynamic system to analyze and predict the spatial distribution and temporal pattern of road crashes. Kasur, an intermediate city of Pakistan, was selected and data including location, time and reasons of accidents for five years (2014-2018) was utilized. Radar charts, Getis-Ord Gi* statistic, Moran's I spatial auto-correlation, and time series indices were engaged to present temporal, spatial and spatial-temporal variation of accidents, using python-based tools and jupyter notebook. A dynamic user interface was created using Github and Tableau to visualize a real-time zoom-able spatiotemporal variation of accidents. The results explain that out of 12 months, October faces the peak while April sees the least of road accidents. 7am is the peak hour for accidents and the weekends record a significantly higher number of road accidents as compared to weekdays. The city core witnesses the major hotspot areas with huge cluster of accidents. The findings contribute towards a well-informed decision support system, the knowledge of spatial analytics and its application in road safety science, and the preparedness of the rescue agencies for rapid response to reduce the impacts of road accidents.

Characteristics, likelihood and challenges of road traffic injuries in China before COVID-19 and in the postpandemic era

Through a review of previous studies, this paper analysed the epidemiological characteristics and attempts to determine the various trends of road traffic injuries (RTIs) in China before and after the coronavirus disease 2019 (COVID-19). This paper proposed effective measures and suggestions for responding to RTIs in China. Moreover, this paper aimed to provide some references for studies on RTIs in the future. According to a reference review, 50 articles related to RTIs were published and viewed in the China National Knowledge Infrastructure (CNKI), Wanfang database, Weipu (VIP) database and PubMed/MEDLINE database. Articles were selected according to the exclusion and inclusion criteria and then classified and summarized. Regarding cases, RTIs in China were highest in summer, autumn, and in rural areas and lowest in February. Men, elderly individuals and people living in rural areas were more susceptible to RTIs. In addition, thanks to effective and proactive policies and measures, the number of RTIs and casualties in China has substantially decreased, while there has been a growing number of traffic accidents along with the increase in nonmotor vehicles. However, it is worth noting that the number of RTIs obviously fell during the COVID-19 pandemic due to traffic lockdown orders and home quarantine policies. Nevertheless, accidents related to electric bicycles increased unsteadily because of the reduction in public transportation use at the same time. The factors that cause RTIs in China can be divided into four aspects: human behaviours, road conditions, vehicles and the environment. As a result, measures responding to RTIs should be accordingly proposed. Moreover, the road traffic safety situation in developing countries was more severe than that in developed countries. RTIs in China showed a downward trend attributed to road safety laws and various policies, and the downward trend was more significant during the COVID-19 pandemic owing to traffic lockdowns and home quarantine measures. It is urgent and necessary to promote road traffic safety, reduce injuries, and minimize the burden of injuries in developing countries.

A Rapid Assessment of Road Crashes in Uganda: Notes from the Field

Background

Road crashes continue to persist on Ugandan roads despite the government’s commendable efforts over many years. This study sought to explore the persistent causes of road crashes, suggest recommendations and evaluate the costs incurred by the government for treating accident victims.

Methods

A rapid cross-sectional study involving both quantitative and qualitative study approaches was performed. Desk reviews and six key informant interviews were conducted with traffic police officers and hospital administrators. Traffic road accident data were abstracted from the Uganda Police Force database for the period of January 2021 to February 2022, to ascertain the magnitude of the problem and its causes.

Results

The causes of road accidents are mainly caused by to human error, weather and the poor state of some roads. The government spends reasonable amounts of money in treating accident victims, at USD 245–3590, yet the funds could instead be used to promote socio-economic development in communities.

Conclusion

Road crashes continue to occur in Uganda, mainly because of human error. We recommend amelioration of the identified causes of road traffic crashes to save lives and conserve limited public resources.

[Assessment of road safety intervention implementation in Benin in 2019]

OBJECTIVE

The study aims to assess the level of implementation of road safety interventions in Benin.

METHOD

The research is based on an evaluative study of road safety aimed to analyze the implementation and logic of road safety interventions, conducted in Benin in 2019. It combined a review of the gray literature and a qualitative component. The data were collected through documents and interviews in structures involved in road safety management.

RESULTS

Road safety was a national priority with one lead institution and several structures involved. There was a lack of consensus among stakeholders, insufficient framework documents, resources, legislative texts, and study data. Few roads were in good condition and very few allowed the separation of two-wheeled vehicles. The vehicle fleet was outdated. Various activities were carried out to raise awareness, to educate the population and to enforce the texts but they were insufficient and poorly coordinated. Reference hospitals had the minimum service to deal with trauma cases. The interventions had not yet resulted in a reduction in the number of injuries and fatalities by accidents, which was increasing.

CONCLUSION

Benin has made great efforts in the area of road safety. However, there are still some shortcomings to take into account.

Impact of Helmet-Wearing Policy on E-Bike Safety Riding Behavior: A Bivariate Ordered Probit Analysis in Ningbo, China

At present, Chinese authorities are launching a campaign to convince riders of electric bicycles (e-bikes) and scooters to wear helmets. To explore the effectiveness of this new helmet policy on e-bike cycling behavior and improve existing e-bike management, this study investigates the related statistical distribution characteristics, such as demographic information, travel information, cycling behavior information and riders’ subjective attitude information. The behavioral data of 1048 e-bike riders related to helmet policy were collected by a questionnaire survey in Ningbo, China. A bivariate ordered probit (BOP) model was employed to account for the unobserved heterogeneity. The marginal effects of contributory factors were calculated to quantify their impacts, and the results show that the BOP model can explain the common unobserved features in the helmet policy and cycling behavior of e-bike riders, and that good safety habits stem from long-term safety education and training. The BOP model results show that whether wearing a helmet, using an e-bike after 19:00, and sunny days are factors that affect the helmet wearing rate. Helmet wearing, evenings during rush hour, and picking up children are some of the factors that affect e-bike accident rates. Furthermore, there is a remarkable negative correlation between the helmet wearing rate and e-bike accident rate. Based on these results, some interventions are discussed to increase the helmet usage of e-bike riders in Ningbo, China.

Alcohol consumption and associated risk factors in Burkina Faso: results of a population-based cross-sectional survey

OBJECTIVES

Lifestyle modifiable risk factors are a leading preventable cause of non-communicable diseases, with alcohol consumption among the most important. Studies characterising the prevalence of alcohol consumption in low-income countries are lacking. This study describes the prevalence of different levels of alcohol consumption in Burkina Faso and its associated factors.

DESIGN

Data from the 2013 Burkina Faso WHO STEPwise Approach to Surveillance survey were analysed. The prevalence of alcohol consumption over the last 30 days was recoded into categories according to WHO recommendations: low, mid or abusive alcohol consumption. Multinomial logistic regression analyses identified factors associated with the different levels of alcohol consumption.

SETTING

Population-based cross-sectional survey in Burkina Faso.

PARTICIPANTS

4692 participants of both sexes aged 25-64 years were included in the study.

RESULTS

In the whole sample, 3559 participants (75.8% (72.5%-78.7%)) were not consuming any alcohol, 614 (12.9% (10.9%-15.3%)) had low alcohol consumption, 399 (8.5% (7.1%-10.1%)) had mid alcohol consumption and 120 (2.7% (2.0%-3.7%)) had abusive consumption. Age was associated with alcohol intake with a gradient effect and older people having a higher level of consumption (adjusted OR (AOR): 2.36, 95% CI (1.59 to 3.51) for low consumption, 2.50 (1.54 to 4.07) for mid consumption and 2.37 (1.01 to 5.92) for abusive consumption in comparison with no consumption). Tobacco consumption was also significantly associated with alcohol intake with a gradient effect, those with higher tobacco consumption being at higher risk of abusive alcohol intake (AOR: 6.08 (2.75 to 13.4) for moderate consumption and 6.58 (1.96 to 22.11) for abusive consumption).

CONCLUSION

Our data showed an important burden of alcohol consumption in Burkina Faso, which varied with age and tobacco use. To effectively reduce alcohol consumption in Burkina Faso, comprehensive control and prevention campaigns should consider these associated factors.

Studies of the effectiveness of transport sector interventions in low- and middle-income countries: An evidence and gap map

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.

Is There a Predisposition towards the Use of New Technologies within the Traffic Field of Emerging Countries? The Case of the Dominican Republic

Technological devices are becoming more and more integrated in the management and control of traffic in big cities. The population perceives the benefits provided by these systems, and, therefore, citizens usually have a favorable opinion of them. However, emerging countries, which have fewer available infrastructures, could present a certain lack of trust. The objective of this work is to detect the level of knowledge and predisposition towards the use of new technologies in the transportation field of the Dominican Republic. For this study, the National Survey on Mobility was administered to a sample of Dominican citizens, proportional to the ONE census and to sex, age and province. The knowledge of ITS topics, as well as the use of mobile applications for mobility, are scarce; however, there was a significant increase that can be observed in only one year. Moreover, technology is, in general, positively assessed for what concerns the improvement of the traffic field, even though there is a lack of predisposition to provide one’s personal data, which is necessary for these devices. The process of technological development in the country must be backed up by laws that protect the citizens’ privacy. Thus, technologies that can improve road safety, mobility and sustainability can be implemented in the country.

Gastrointestinal Tract Colonization Rate of Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacteria and Associated Factors Among Orthopaedic Patients in a Tertiary Hospital in Tanzania: Implications for Infection Prevention

Background

The dual burden of road traffic accidents and antimicrobial resistance in orthopaedic infections is challenging already strained health-care systems. Limited information exists in Tanzania on antimicrobial resistance surveillance to delineate the potential sources of multi-drug-resistant bacteria for specific mitigation strategies among orthopaedic patients.

Methods

A longitudinal study was conducted at Bugando Medical Centre in Mwanza city between January and May 2020. It involved the collection of rectal swabs/stools, hand swabs, and environmental sampling to identify extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria. Participants’ data were collected using a structured questionnaire and analysed to determine factors associated with ESBL colonization among index orthopaedic patients and correlates with other ESBL sources using OR (95% CI) and a cut-off p-value of ≤0.05.

Results

We found that 47.2% (125/265) of index patients, 77.8% (14/18) of neighbouring patients, 8.3% (2/24) of health-care workers, 72.2% (13/18) of non-medical caregivers, and 31.4% (27/86) of samples taken from the hospital environment had ESBL producers. Escherichia coli and Klebsiella spp. predominated among participants and Acinetobacter spp. predominated in the environmental samples. Patients with open fractures had increased odds of being colonized with ESBL producers [OR (95% CI): 2.08 (1.16–3.75); p=0.015]. The floor below patients’ beds was commonly contaminated; however, the odds of environmental contamination decreased on the third round of sampling [OR (95% CI: 0.16 (0.04–0.67); p=0.012], apparently as a result of parallel infection prevention and control responsive measures against coronavirus disease 2019 (COVID-19).

Conclusion

We found a high occurrence of ESBL colonization among participants and in the environmentat this tertiary hospital. The importance of routine ESBL surveillance among orthopaedic patients with open fractures on admission and strengthened decontamination of health-care premises is reiterated.

Testing the waters: Syndemic gastrointestinal distress in Lambaréné, Gabon, 1926-1932

This paper argues that a cluster of pathogens, hazardous labor conditions, and environmental constraints rendered chronic gastrointestinal distress fatal for African laborers living near Lambaréné, Gabon during the 1920s. Application of syndemic theory and epidemiological methods on patient records at Hospital Schweitzer, the central hospital of the region, explain how a seemingly simple diagnosis of chronic gastrointestinal distress belied a complex web of worsening biological and social outcomes for laborers in the tropical forests of central Gabon. An analysis of the syndemic suffering of GI patients reveals how the dysentery pathogen became tied to the peaks and valleys of the colonial economy, and in particular, the colonial extraction of tropical hardwoods. These processes culminated in the summer of 1929 when the highest number of timber exports coincided with the deadliest months of dysentery outbreak for the patient population at Hospital Schweitzer. This case study proposes syndemics as an effective theoretical framework to research historical precedents of the entanglement of people, pathogens, and illness.

Risky driving behaviour in Abu Dhabi, United Arab Emirates: a cross-sectional, survey-based study

Background

Traffic collision fatality rates per mile travelled have declined in Abu Dhabi similar to many developed countries. Nevertheless, the rate is still significantly higher than the average of countries with similar GDP and socio-demographic indicators. The literature on the subject in the UAE is limited especially in the area of studying drivers behaviour. This study aims to find determinants of risky driving behaviours that precipitate having a road traffic collision (RTC) in the United Arab Emirates (UAE).

Methods

A cross-sectional, survey-based study was employed. Participants were 327 active drivers who were attending Abu Dhabi Ambulatory Health Care Services clinics. They were provided with a questionnaire consisting of demography, lifestyle history, medical history, driving history, and an RTC history. They were also given a driving behaviour questionnaire, a distracted driving survey, depression screening and anxiety screening.

Results

Novice drivers (less than 25 years old) were 42% of the sample and 79% were less than 35 years. Those who reported a history of an RTC constituted 39.8% of the sample; nearly half (47.1%) did not wear a seatbelt during the collision. High scores in the driving behaviour questionnaire and high distraction scores were evident in the sample. Most distraction-prone individuals were young (90.5% were less than 36 years old). High scores in the driving behaviour questionnaire were also associated with high distraction scores (p < 0.001). Respondents with high depression risk were more likely to be involved in the RTC. With each one-point increase in the driver’s distraction score, the likelihood of a car crash being reported increased by 4.9%.

Conclusion

Drivers in the UAE engage in risky behaviours and they are highly distracted. Some behaviours that contribute to severe and even fatal injuries in RTCs include failing to wear a seatbelt and being distracted. Younger people were more likely distracted, while older drivers were more likely to have higher depression scores. Depression is suggested as a determinant factor in risky driving. These findings are informative to other countries of similar socioeconomic status to the UAE and to researchers in this field in general.

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review

BACKGROUND

Neurotrauma is an important global health problem. The largest cause of neurotrauma worldwide is road traffic collisions (RTCs), particularly in low- and middle-income countries (LMICs). Neurotrauma and RTCs are preventable, and many preventative interventions have been implemented over the last decades, especially in high-income countries (HICs). However, it is uncertain if these strategies are applicable globally due to variations in environment, resources, population, culture and infrastructure. Given this issue, this scoping review aims to identify, quantify and describe the evidence on approaches in neurotrauma and RTCs prevention, and ascertain contextual factors that influence their implementation in LMICs and HICs.

METHODS

A systematic search was conducted using five electronic databases (MEDLINE, EMBASE, CINAHL, Global Health on EBSCO host, Cochrane Database of Systematic Reviews), grey literature databases, government and non-government websites, as well as bibliographic and citation searching of selected articles. The extracted data were presented using figures, tables, and accompanying narrative summaries. The results of this review were reported using the PRISMA Extension for Scoping Reviews (PRISMA-ScR).

RESULTS

A total of 411 publications met the inclusion criteria, including 349 primary studies and 62 reviews. More than 80% of the primary studies were from HICs and described all levels of neurotrauma prevention. Only 65 papers came from LMICs, which mostly described primary prevention, focussing on road safety. For the reviews, 41 papers (66.1%) reviewed primary, 18 tertiary (29.1%), and three secondary preventative approaches. Most of the primary papers in the reviews came from HICs (67.7%) with 5 reviews on only LMIC papers. Fifteen reviews (24.1%) included papers from both HICs and LMICs. Intervention settings ranged from nationwide to community-based but were not reported in 44 papers (10.8%), most of which were reviews. Contextual factors were described in 62 papers and varied depending on the interventions.

CONCLUSIONS

There is a large quantity of global evidence on strategies and interventions for neurotrauma and RTCs prevention. However, fewer papers were from LMICs, especially on secondary and tertiary prevention. More primary research needs to be done in these countries to determine what strategies and interventions exist and the applicability of HIC interventions in LMICs.

Are Primary Trauma Care (PTC) courses beneficial in low- and middle-income countries - A systematic review

BACKGROUND

Injuries remain an important public health concern, resulting in considerable annual morbidity and mortality. In low- and middle-income countries (LMICs), the lack of appropriate infrastructure, equipment and skilled personnel compound the burden of injury, leading to higher mortality rates. As Advanced Trauma Life Support (ATLS) courses remain uneconomical and inappropriate in LMICs, the Primary Trauma Care (PTC) course was introduced to provide an alternative that is both sustainable and appropriate to local resources.

METHODS

A systematic review was performed in May 2019, utilising MEDLINE, EMBASE, Cochrane Library and Google Scholar. All studies reporting patient related outcomes (mortality and morbidity rates) and course participant related outcomes (knowledge, confidence and skills) in LMICs were included. PRISMA guidelines were adhered to throughout.

RESULTS

Nine observational studies were identified (Level 3 evidence). Six studies reported improved knowledge in injury management post-PTC course (p < 0.05). Two studies reported improvements in confidence (p < 0.05) and one on skill attainment (p < 0.0001). One study reported a reduction in mortality rates post-PTC course (p < 0.01).

CONCLUSION

Departmental, institutional and personal improvements may occur in clinical practice as a result of formal PTC training of trauma team members in LMICs. Further high-quality research is needed to evaluate this course's effects on observed change in clinical practice and patient outcomes. This may require long-term observational and epidemiological studies to assess improvements in morbidity and mortality. PROSPERO Registration Number: CRD42019133986.

Safe mobility, socioeconomic inequalities, and aging: A 12-year multilevel interrupted time-series analysis of road traffic death rates in a Latin American country

As the resources for road safety in developing countries are scarce and unevenly distributed, vulnerable road users -such as the elderly- may be particularly at risk of road traffic deaths. To date, the impact of road safety measures over the rate of road traffic deaths in older adults (60 years or older), considering the within-country socioeconomic inequalities, has not been explored in developing nations. This study takes the Chilean case as an example -with its 2005 traffic law reform as one of the road safety measures investigated-, in which open data available from official national sources for all its 13 regions over the 2002-2013 period were used for a multilevel interrupted time-series analysis. A statistically significant secular reduction of the rates of road traffic deaths in the elderly population was found (incidence rate ratio [IRR] 0.95, 95% confidence interval [CI] 0.91 to 0.99), but no evidence for a significant intercept or slope change after the traffic law reform was observed. Regions with the highest number of traffic offenses prosecuted in local police courts had lower rates of road traffic deaths in older adults (IRR 0.95, 95% CI 0.90 to 1.00), and those regions in the third (IRR 1.61, 95% CI 1.16 to 2.25) and the fifth (IRR 1.66, 95% CI 1.08 to 2.54) quintiles of socioeconomic deprivation had higher rates of road traffic deaths in the elderly. Such findings strongly support the conceptualization of the road safety of seniors in developing countries as a social equity issue, with implications for the design of traffic regulations and road environments.

Mapping global evidence on strategies and interventions in neurotrauma and road traffic collisions prevention: a scoping review protocol

INTRODUCTION

Neurotrauma is an important global health problem. This 'silent epidemic' is a major cause of death and disability in adolescents and young adults, with significant societal and economic impacts. Globally, the largest cause of neurotrauma is road traffic collisions (RTCs). Neurotrauma and RTCs are largely preventable, and many preventative strategies and interventions have been established and implemented over the last decades, particularly in high-income countries. However, these approaches may not be applicable globally, due to variations in environment, resources, population, culture and infrastructure. This paper outlines the protocol for a scoping review, which seeks to map the evidence on strategies and interventions in neurotrauma and RTCs prevention globally, and to ascertain contextual factors that influence their implementation.

METHODS AND ANALYSIS

This scoping review will use the established methodology by Arksey and O'Malley. Eligible studies will be identified from five electronic databases (MEDLINE, EMBASE, CINAHL, Global Health/EBSCO and Cochrane Database of Systematic Reviews) and grey literature sources. We will also carry out bibliographical and citation searching of included studies. A two-stage selection process, which involves screening of titles and abstracts, followed by full-text screening, will be used to determine eligible studies which will undergo data abstraction using a customised, piloted data extraction sheet. The extracted data will be presented using evidence mapping and a narrative summary.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review, which is the first step in a multiphase public health research project on the global prevention of neurotrauma. The final review will be submitted for publication to a scientific journal, and results will be presented at appropriate conferences, workshops and meetings. Protocol registered on 5 April 2019 with Open Science Framework (https://osf.io/s4zk3/).

Road Safety in Low-Income Countries: State of Knowledge and Future Directions

Road safety in low-income countries (LICs) remains a major concern. Given the expected increase in traffic exposure due to the relatively rapid motorisation of transport in LICs, it is imperative to better understand the underlying mechanisms of road safety. This in turn will allow for planning cost-effective road safety improvement programs in a timely manner. With the general aim of improving road safety in LICs, this paper discusses the state of knowledge and proposes a number of future research directions developed from literature reviews and expert elicitation. Our study takes a holistic approach based on the Safe Systems framework and the framework for the UN Decade of Action for Road Safety. We focused mostly on examining the problem from traffic engineering and safety policy standpoints, but also touched upon other sectors, including public health and social sciences. We identified ten focus areas relating to (i) under-reporting; (ii) global best practices; (iii) vulnerable groups; (iv) disabilities; (v) road crash costing; (vi) vehicle safety; (vii) proactive approaches; (viii) data challenges; (ix) social/behavioural aspects; and (x) capacity building. Based on our findings, future research ought to focus on improvement of data systems, understanding the impact of and addressing non-fatal injuries, improving estimates on the economic burden, implementation research to scale up programs and transfer learnings, as well as capacity development. Our recommendations, which relate to both empirical and methodological frontiers, would lead to noteworthy improvements in the way road safety data collection and research is conducted in the context of LICs.