Pattern of Road Traffic Injuries in Rural Bangladesh: Burden Estimates and Risk Factors

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.

Factors associated with road traffic injury in a high-risk zone of Bangladesh: a mixed-method study

INTRODUCTION

Road traffic injuries are a significant public health issue in low-income and middle-income countries. This study was designed to explore the pattern and factors associated with road traffic injury in a high-risk zone of Bangladesh.

METHOD

This mixed-method study included a total of 363 road traffic injury victims for the quantitative component, and 10 traffic-related officials and 10 drivers for the qualitative element. Data were collected using a pretested questionnaire, key informant interviews and a focus group discussion using a focus group discussion guide. Quantitative and qualitative analyses were done using Stata V.17 and NVivo V.12, respectively.

RESULTS

Most participants were male, illiterate and young (<30 years) with age averaging 31.50±9.16 years. Of all road traffic injury victims, most had mild (45.18%) injuries, and the least had severe (5.79%) injuries, with head being the most common site (34.44%). The highest proportion of injuries were sustained by motor vehicle drivers (57.58%), followed by cyclists/rickshaw pullers (22.59%) and passengers (19.83%). Most vehicles were new (75.21%), and the rest were old (24.79%). Nearly one-third of the participants did not know about driving rules. The presence of knowledge was associated with less severe injury (p=0.031) compared with the absence of knowledge. The qualitative component of the study identified several factors related to road traffic injury, including driver factors (lack of sleep, bad driving habits and lack of helmets), driving activity factors (ignoring rules, overtaking, crossing speed limits and using bright headlights), road-related factors (broken roads, unplanned curves and angles, the need for spacious streets and the lack of appraisal of previous crash records) and traffic control factors (stringent traffic rules, effective implementation and training on using speed guns).

CONCLUSION

The factors related to road traffic injury identified in this study could be used to plan targeted interventions for road safety improvement.

Thirty-year trends of triple burden of disease in the adult population of Pakistan

BACKGROUND

The triple burden of disease, i.e. communicable diseases, non-communicable diseases and injuries, has significantly affected the healthcare system of Pakistan during the last three decades. Therefore, this study aims to determine and analyse the 30-year disease burden trends through prevalence, death rates and percentages.

METHODS

The data for the last three decades, i.e. 1990 to 2019, was extracted from the Global Burden of Disease for Pakistan. Percentage change in prevalence and deaths over 30 years was calculated. Poisson regression analysis was performed to evaluate the triple disease burden trends and the incidence rate ratio.

RESULTS

A relative decrease of 23.4% was noted in the prevalence rate of communicable diseases except for human immunodeficiency virus and dengue fever. A relative increase of 1.4% was noted in the prevalence rate of non-communicable diseases. A relative increase of 56.1% was recorded in the prevalence rate of injuries. The prevalence rate ratios of communicable diseases significantly decreased to 0.9796 [95% CI: 0.9887-0.9905], but the prevalence rate of injury increased to 1.0094 [95% CI: 1.0073-1.01145], respectively.

CONCLUSION

Pakistan must take the next steps and develop strategies to decrease this burden and mortality rates in the population to create better outcomes and therefore help the healthcare system overall.

A qualitative exploration of the facility-based trauma care for Road Traffic Crash patients in Bangladesh: When only numbers do not tell the whole story

OBJECTIVE

Bangladesh is currently undergoing an epidemic of road traffic crashes (RTCs). In addition to morbidity and mortality, the economic loss from RTC as per cent of gross domestic product is comparatively higher than in countries with similar socioeconomic conditions. However, trauma care remained poorly developed as a specialty and service delivery mechanism. This study aimed to examine the current situation of in-hospital trauma care after RTCs to inform the design of a comprehensive service for Bangladesh.

DESIGN, SETTING AND PARTICIPANTS

This qualitative study attempted to elicit stakeholders' perceptions and experiences of managing RTCs through in-depth interviews and focus group discussions. Three districts and Dhaka city were selected based on the frequency of occurrence of RTCs. Fifteen in-depth interviews and 5 focus group discussions were conducted with 38 RTC patients, their relatives and community members in the catchment areas of 11 facilities managing trauma patients. Key informant interviews were conducted with 21 service providers and 17 key stakeholders/policy-makers.

RESULTS

Hospital-based trauma care was generally poor in primary and secondary-level facilities. There was no triage area or triage protocol in the emergency rooms, no trained staff for trauma care, no dedicated RTC patient register and scarce life-saving equipment. Only in Dhaka-based tertiary hospitals was trauma care prioritised. These hospitals follow Advanced Trauma Life Support guidelines and maintain an RTC logbook. Emergency diagnostic services were not always available in the hospitals. Most RTC patients were males; the female participants were additionally vulnerable to physical and mental trauma. Affected people avoided taking legal action considering it a lengthy, complicated and ultimately ineffective process.

CONCLUSION

The trauma care services currently available in the studied health facilities are very rudimentary and without the necessary human and financial resources. This needs urgent attention from policymakers, programmers and practitioners to reduce morbidity and mortality from the current epidemic of RTCs in Bangladesh.

Trauma Care Scenarios Following Road Traffic Crashes in Bangladesh: A Scoping Review

INTRODUCTION

We conducted a scoping review of the trauma care situation following road traffic crashes (RTCs) in Bangladesh to inform the design of a comprehensive program for mitigating associated morbidity and mortality.

METHODS

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis approach to select relevant articles, documents, and reports following a set of inclusion and exclusion criteria. In total, 52 articles and 8 reports and program documents were included in the analysis. We adopted a mixed studies review method for synthesizing evidence and organized information by key themes using a data extraction matrix.

RESULTS

Findings revealed RTC mortality to be 15.3 per 100,000 population in 2019. Pedestrians, cyclists, and motorcyclists were the most vulnerable groups succumbing to moderate to grave injuries. We found that 81% of motorcycle victims did not use any safety device, an estimated 1,844 people per day suffered different degrees of injury, and 29 people per day became permanently disabled. The ambulance-based prehospital care operated in a disjointed and disorganized manner without standard operating procedures and dispatch structure. This disorganization and a lack of a universal communication system led to treatment delay, resulting in chronic disability for the victims. Injury-related patients occupied about 33% of hospital beds, 19% of which were RTC victims. The cost of care for these victims involved substantial out-of-pocket spending, which sometimes reached catastrophic levels. Since 2009, the management of RTCs has deteriorated with a concomitant increase in morbidity and mortality, resulting in a drain on people's lives and livelihoods.

CONCLUSION

The current situation regarding post-crash care in the country, especially when RTCs are on the rise, is not compatible with reaching the SDG targets 3.6 and 11.2 or the government's stated goal of achieving universal health coverage by 2030.

Lives Saved in Low- and Middle-Income Countries by Road Safety Initiatives Funded by Bloomberg Philanthropies and Implemented by Their Partners between 2007-2018

Over the past 12 years, Bloomberg Philanthropies (BP) and its partner organisations have implemented a global road safety program in low- and middle-income countries. The program was implemented to address the historically increasing number of road fatalities and the inadequate funding to reduce them. This study evaluates the performance of the program by estimating lives saved from road safety interventions implemented during the program period (2007–2018) through to 2030. We estimated that 311,758 lives will have been saved by 2030, with 97,148 lives saved up until 2018 when the evaluation was conducted and a further 214,608 lives projected to be saved if these changes are sustained until 2030. Legislative changes alone accounted for 75% of lives saved. Concurrent activities related to reducing drink driving, implementing legislative changes, and social marketing campaigns run in conjunction with police enforcement and other road safety activities accounted for 57% of the total estimated lives saved. Saving 311,758 lives with funding of USD $259 million indicates a cost-effectiveness ratio of USD $831 per life saved. The potential health gains achieved through the number of lives saved from the road safety initiatives funded by Bloomberg Philanthropies represent a considerable return on investment. This study demonstrates the extent to which successful, cost-effective road safety initiatives can reduce road fatalities in low- and middle-income countries.

Patterns of injuries and injury severity among hospitalized road traffic injury (RTI) patients in Bangladesh

Background

Road traffic injuries (RTIs) are one of the key public health issues worldwide causing 1.3 million deaths every year. This study aimed to determine the patterns of injuries due to road traffic accidents (RTAs), the severity of injuries, and factors associated with injury severity.

Methodology

A cross-sectional study was conducted among RTA victims, who attended two large tertiary care hospitals located inside the Dhaka metropolitan area, through structured interview between 28 January and 22 March 2020.

Results

Among 375 RTI patients, a total of 1390 injuries were recorded among interviewed patients, yielding a mean of 3.7 injuries per patient. The most frequently injured systems were external (n = 351), lower limb (n = 235), head and neck (n = 151), and face (n = 150). The mean ISS were 20.96 ± 12.027 with a maximum of 65 and a minimum of 4. Among patients, 87 (23.20%) had a severe injury, and 37 (9.87%) patients were critically injured. A statistically significant variation in ISS was observed in ANOVA among various categories of age, education, occupation, and purpose of going outside, vehicle type and fitness, accident type, road type, times required in hospitalization, and death history (p < 0.05).

Conclusions

Our study has revealed several important findings which will help stakeholders and policymakers devise better policies to reduce RTA and RTA related injuries in Bangladesh.

Routine mortality surveillance to identify the cause of death pattern for out-of-hospital adult (aged 12+ years) deaths in Bangladesh: introduction of automated verbal autopsy

BACKGROUND

In Bangladesh, a poorly functioning national system of registering deaths and determining their causes leaves the country without important information on which to inform health programming, particularly for the 85% of deaths that occur in the community. In 2017, an improved death registration system and automated verbal autopsy (VA) were introduced to 13 upazilas to assess the utility of VA as a routine source of policy-relevant information and to identify leading causes of deaths (COD) in rural Bangladesh.

METHODS

Data from 22,535 VAs, collected in 12 upazilas between October 2017 and August 2019, were assigned a COD using the SmartVA Analyze 2.0 computer algorithm. The plausibility of the VA results was assessed using a series of demographic and epidemiological checks in the Verbal Autopsy Interpretation, Performance and Evaluation Resource (VIPER) software tool.

RESULTS

Completeness of community death reporting was 65%. The vast majority (85%) of adult deaths were due to non-communicable diseases, with ischemic heart disease, stroke and chronic respiratory disease comprising about 60% alone. Leading COD were broadly consistent with Global Burden of Disease study estimates.

CONCLUSIONS

Routine VA collection using automated methods is feasible, can produce plausible results and provides critical information on community COD in Bangladesh. Routine VA and VIPER have potential application to countries with weak death registration systems.

Incidence and pattern of road traffic injuries in tribal population of Jharkhand: One-year study in a tertiary care teaching hospital

Background and Aim:

Road traffic injuries (RTIs) are a leading cause of mortality and morbidity globally. This study aimed to assess the incidence and pattern of RTIs in the tribal population of Jharkhand.

Methods and Materials:

This prospective observational study was conducted for a period of 1 year (June 2018 to May 2019) at the Rajendra Institute of Medical Sciences, Ranchi, Jharkhand. A pretested semi-structured questionnaire was administered. A total of 1713 road traffic accident (RTA) victims belonging to tribal population were interviewed during the study period. Data were entered in a Microsoft Excel sheet and analyzed using Statistical Package for Social Sciences (SPSS) version 16.

Results:

There were 1258 (73.4%) males and 455 (26.6%) females. The majority (31.4%) of patients belonged to the age group of 21–30 years, followed by 19.2% in the age group of 31–40 years. The majority (52.13%) of RTAs involved a two-wheeler vehicle. Head injury was the most common type of injury (40.86%), followed by lower limb injury (26.68%). Common upper limb injuries were in the humerus and radius and ulna region. The majority of lower limb injuries involved tibia and femur. Common thoracic-abdomen injuries were soft tissue injury and lung contusion. Drunk driving (alcohol influence) was seen in 34.68% of cases of RTI.

Conclusions:

RTA is a major public health problem which needs to accelerate the efforts of road safety preventive measures. Road safety education should be promoted.

Applying the Three Delays Model to understand emergency care seeking and delivery in rural Bangladesh: a qualitative study

OBJECTIVES

The Three Delays Model has been commonly used to understand and prevent maternal mortality but has not been systematically applied to emergency medical conditions more generally. The objective of this study was to identify delays in emergency medical care seeking and delivery in rural Bangladesh and factors contributing to these delays by using the Three Delays Model as a framework.

DESIGN

A qualitative approach was used. Data were collected through focus group discussions and in-depth interviews using semistructured guides. Two analysts jointly developed a codebook iteratively and conducted a thematic analysis to triangulate results.

SETTING

Six unions in Raiganj subdistrict of Bangladesh.

PARTICIPANTS

Eight focus group discussions with community members (n=59) and eight in-depth interviews with healthcare providers.

RESULTS

Delays in the decision to seek care and timely receipt of care on reaching a health facility were most prominent. The main factors influencing care-seeking decisions included ability to recognise symptoms and decision-making power. Staff and resource shortages and lack of training contributed to delays in receiving care. Delay in reaching care was not perceived as a salient barrier. Both community members and healthcare providers expressed interest in receiving training to improve management of emergency conditions.

CONCLUSIONS

The Three Delays Model is a practical framework that can be useful for understanding barriers to emergency care and developing more tailored interventions. In rural Bangladesh, training community members and healthcare providers to recognise symptoms and manage acute conditions can reduce delays in care seeking and receiving adequate care at health facilities.

Road traffic injuries in a Nigerian referral trauma center: Characteristics, correlates, and outcomes

Background:

Globally, road traffic injuries (RTIs) are a leading cause of disability and trauma-related deaths. We aimed to describe the clinical and epidemiological characteristics and outcomes of RTIs in our environment to provide the evidence for effective control measures.

Methods:

This was a 1-year retrospective study of all patients with RTIs treated at the University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

Results:

Four hundred and twenty-one patients with 484 injuries were studied. The mean age of the patients was 34.4 ± 14.6 years, and the male-to-female ratio was 3.3:1. Most of the injuries occurred on intercity roads/highways (48.7%) and involved motorcycle crashes (31%). Soft-tissue injuries (27.7%) and fractures (21.9%) were the most common types of injuries. The lower extremities were the most common sites of injury. The mean injury-arrival interval was 23.2 ± 2.4 h. The injury severity score (ISS) ranged from 1 to 50, with a mean of 9.2 ± 2.9. The 1-year mortality rate was 10.7%. Traumatic brain injury, open vehicular injuries, and increased ISS were the potential risk factors for mortality.

Conclusion:

Soft-tissue injuries and fractures were the most common types of injuries. The majority of the injuries occurred on the inter-city roads and highways and involved head-on-collisions with motorcycles. The young male adults were the most commonly affected age group.

Epidemiological Survey on Traffic Accident Mortality Referred to the Forensic Medical Center of Chaharmahal and Bakhtiari Province During 2005-2016

Background and aims: The World Health Organization has listed Iran as the country with the highest number of driving accidents worldwide. Chaharmahal and Bakhtiari is among the top ten provinces in Iran. The aim of this study was to carry out an epidemiological survey on driving accidents resulting in deaths that were referred to the Forensic Medical Center. Methods: In this cross-sectional study, the data were obtained from the Forensic Medical Center in Shahrekord, the provincial capital, during 2005-2016. Data were analyzed using descriptive statistics and the chi-square test by SPSS. Results: The number of registered accidents causing death was 3001. The highest number of accidents (13.5%) occurred from August 23rd to September 22nd, which equates to the last months of the summer according to the solar calendar. Location wise, the highest number of accidents happened in Shahrekord (58.2%). In addition, men and married people were more involved in accidents compared to women and singles. The age group of 21-25 had the most number of accidents. Further, the main road had the highest percentage of accidents (86.7%) compared to freeways, by-ways, and rural roads. Finally, head trauma 1634 (60.7%) was the most important cause of death in people who were in car accidents. Conclusion: Based on these results, policymakers and planners have to carry out necessary positive interferences and plans in order to reduce the number of factors which increase car accidents. Eventually, accidents are usually caused by multiple elements and this makes it necessary to review and optimize the operational output of responsible organizations and offices and the cooperation between them.

Prevalence and Pattern of Road Traffic Accidents among Commercial Motorcyclists in the Central Tongu District, Ghana

Background

The World Health Organisation estimates that 1.35 million people die as a result of road traffic crashes. Motorcycles as a means of transport are increasingly becoming the preferred and easiest means of transportation for most people in developing countries despite the associated risk. This study determined the prevalence and pattern of motorcycle crashes in Adidome among commercial motorcyclists.

Methods

A descriptive, cross-sectional study design was used as 114 commercial motorcyclists were recruited to respond to a pretested research questionnaire in the Adidome district of the Volta Region. Data were analyzed using SPSS, version 22.0. Data were presented as simple descriptive statistics. A chi-square relationship was determined using the demographic variables, and the history of accident at a 95% confidence interval with 0.05 was considered as statistically significant.

Results

The prevalence of road traffic crashes at Adidome was 64.0%. Motorcyclists (74.0%) were reported to have been involved in crashes in the past one year prior to the study. Motorcyclists attributed the last accident to excessive speeding (31.5%) and bad roads (23.3%), this accident as a result of colliding with another motorcycle (50.7%), and slippery surfaces (24.7%). The majority (63.0%) of the respondents had an accident once. The consumption of alcohol was associated with the occurrence of an accident as 34.2% occurred among cyclists who drank alcohol, compared with 29.8% who did not (p < 0.05).

Conclusion

There should be strict implementation of current road traffic regulations of Ghana by the MTTD of the Ghana Police Service, and penalties should be awarded against anybody caught riding a motorcycle under the influence of alcohol. Helmet and other protective devices must be made compulsory for motorcycle riders to prevent injuries, especially head injuries, if an accident occurs.

Social and environmental risk factors for road traffic injuries among children under five in rural China

BACKGROUND

Road traffic injuries (RTIs) have become a considerable issue for children. In China, RTIs are among the top 3 contributors to injury-related mortality and disability-adjusted life years. The present study aimed to evaluate social and environmental factors that may contribute to RTIs among children under 5 in rural areas of China.

METHODS

The study was based on 1 year of data (October 1, 2015 to September 30, 2016) from the National Maternal and Child Health Surveillance System (NMCHSS) from all districts in 334 National Maternal and Child Health Surveillance Districts in 30 Chinese provinces, autonomous regions, and municipalities. Data were analyzed to identify environmental, social, and primary caregiver factors related to RTIs among children under 5.

RESULTS

Based on data for the 279 children registered in the NMCHSS during the study period, incidence of RTIs increased with increasing age and was higher for boys than girls. Risk of RTIs depended on distances from the child's home to roads and playgrounds. Enrollment in kindergarten and characteristics of primary caregivers affected risky road behaviors by children. Most primary caregivers (67.4%) reported never using child car seats, and 70.6% reported never using a child helmet. Among primary caregivers without a driver's license, 24.8% reported having driven motor vehicles or motorcycles.

CONCLUSIONS

The living environment and behaviors of primary caregivers can affect risk of RTIs in children younger than 5 years in rural China. Road safety awareness should be strengthened at the community and kindergarten levels.

Burden of Lesser-Known Unintentional Non-Fatal Injuries in Rural Bangladesh: Findings from a Large-Scale Population-Based Study

Around 90% of all fatal and non-fatal unintentional injuries occur in low- and middle-income countries (LMICs). The magnitude of unintentional injuries is unclear due to limited research and data. This paper describes the burden of lesser-known injuries (LKIs-cut injuries, unintentional poisoning, machine injuries, electrocution, injury by blunt objects, and suffocation) in rural Bangladesh, using data from the Saving of Lives from Drowning (SoLiD) project in Bangladesh. Descriptive statistics were used to report counts and rates of injuries by socio-demographic factors, injury characteristics, and circumstantial details. The annual morbidity rate of LKIs was 6878 injuries per 100,000 persons, involving 3.4% (40,520) of the population. Cut injury (44,131.2/100,000 per year) and injury by blunt objects (19768.6/100,000 per year) attributed in large numbers to the overall burden of LKIs. Males (66.1%) suffered more injuries than females. More than half (52.9%) occurred among people aged 25 to 64 years. Those involved in agriculture suffered the most injuries, mainly cut injuries (9234.1/100,000 per year) and machine-related injuries (582.9/100,000 per year). Most injuries occurred in the home setting. Increased awareness about packaging, storage, and the proper handling of appliances can help lower the frequency of LKIs. Safe architecture and awareness about home injuries is required to reduce injuries occurring in the home environment.