Road Traffic Injuries in Developing Countries
ABSTRACT & COMMENTARY
Synopsis: This study re-enforces the need for travelers to follow some common sense precautions to avoid motor vehicle accidents.
Source: Odero W, et al. Road traffic injuries in developing countries: A comprehensive review of epidemiological studies. Trop Med Internatl Health 1997;2:445-460.
Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three-quarters of road accidents occur in developing countries, and 80% of the casualties occur in men. In order to establish what is known in the developing world concerning motor vehicle accidents, prior to conducting further research or promoting public health policies on road safety, Odero and colleagues examined the literature for available evidence concerning the epidemiology of traffic injuries, with the objective of identifying and summarizing available information about the epidemiology of motor vehicle crashes in developing countries and examining evidence for an association with alcohol. Published and unpublished reports on road traffic accidents and developing countries from 1966 to May 1994 were sought for by (a) electronic searches of MEDLINE, SCISEARCH, and LILAC using a full text search of "accidents or injuries or trauma;" (b) Relevant references cited in articles identified by (a) above were located; (c) References in existing reviews on traffic crashes in developing countries; (d) Unpublished documents, official accident statistics reports, and conference proceedings on road traffic accidents. Of the 73 studies identified, 55 were retrospective while 18 were prospective.
Fatality rates in relation to vehicle ownership varied from 3.0 per 10,000 in Saudi Arabia to 301.9 in Haiti. Other examples included Kenya, 68; Zambia, 118; Uganda, 113.6; India, 12.4; and Papua New Guinea, 67.4 per 10,000 vehicles. By comparison, in Canada 2.0 fatalities occurred per 10,000 vehicles in 1995.1 In the developing world, there was an apparent correlation between an increase in vehicle ownership with low mortality rate per 10,000 vehicles, suggesting that more experience with motor vehicles leads to fewer accidents, perhaps because of the institution of regulations or laws governing usage. In eight studies, those in the age group 15-44 comprised between 48% and 78% of all traffic casualties, whereas in seven studies, 46-75% of accidents occurred in the 20-39 age range. Although the groupings overlap, the results clearly indicate the excess representation of adolescents and young adults as motor vehicle casualties. Most studies described a consistent predominance of males over females, with males comprising between 67% and 99% of all motor vehicle casualties. Pedestrian fatalities were highest in 75% of the studies, followed by passengers and drivers. Pedal and motorcyclists killed ranked first in India and Suriname. A relatively high proportion of cyclist injuries in Southeast Asian countries, ranging from 39% to 63%, reflects the effects of traffic mix on the roads in the region.
Most studies showed that between 60% and 80% of casualties were injured during the day. The highest night-time traffic injuries occurred between 1800 and 2400 hours. Although there is less traffic at night, the risk and probability of injury is likely to be much higher than during the day. The greatest incidence of traffic injury occurred during the weekends compared to mid-week days. Alcohol prevalence in drivers ranged between 30% and 55% in five studies undertaken in South Africa, Zambia, and Papua New Guinea. It ranged from 48% to 69% in three studies in Puerto Rico. On the basis of police reports, 15 of the studies mentioned excessive speed and 14 studies suggested driver negligence were judged by the police as the main causal factors for crashes.
COMMENT BY JAY S. KEYSTONE, MD, MSC
Motor vehicle crashes are the leading cause of death in adolescents and young adults.2 Of the estimated 856,000 road deaths occurring annually worldwide, 74% are in developing countries.3 Dramatic increases in the proportion and absolute number of traffic deaths have been witnessed in a number of developing countries, while they have decreased by more than 20% in industrialized nations.4 In Nigeria and Kenya, for example, a five-fold increase in traffic-related fatalities was observed over the last 30 years.5,6 African and Asian countries with relatively low vehicle densities are experiencing substantial higher fatality rates per 10,000 vehicles than industrialized European and North American states. Human error is estimated to account for 64-95% of all traffic crashes in developing countries.7 A high prevalence of poorly maintained vehicles that often transport many more people than they are designed to carry, lack of safety belt and helmet use, poor road design and maintenance, poor driver education, inadequate policing of existing traffic laws, and the traffic mix on roads are other factors that contribute to the high rate of crashes in less developed countries. With the exception of cardiovascular disease, motor vehicle accidents account for the highest number of deaths among travelers.8-11 In American travelers, motor vehicle accidents accounted for 25% of all deaths compared with 18% of deaths for Australian travelers and 21% for Scottish travelers. Deaths from road traffic accidents do seem to be a major hazard for younger travelers to whom more attention should be paid to encourage ways in which they can avoid hazardous situations. The above study provides no surprising information but does re-enforce the need for travelers to follow some common sense precautions to avoid motor vehicle accidents. If possible, travelers should avoid riding in overcrowded public vehicles and traveling at night, especially in rural areas. Also, they should resist the urge to travel by motorcycle, even though it is an ideal way to view the world (and, unfortunately, to meet one’s maker). Travelers should not be afraid to insist that their drivers (taxis or private chauffeurs) in developing countries obey traffic laws (where they exist) and drive at reasonable speeds according to road conditions. Unfortunately, seat belts and infant car seats are often nowhere to be found. Since, in practice, no preventive measure guarantees safety, adequate health insurance should be obtained before venturing abroad.
References
1. Transport Canada. Canadian motor vehicle traffic collision statistics 1995;1-4.
2. Smith GS, Barss PG. Unintentional injuries in developing countries: The epidemiology of a neglected problem. Epidemiol Rev 1991;13:228-266.
3. World Bank. Investing in Health. World Development Report 1993 London: Oxford University Press.
4. Ross A, et al. Towards safer roads in developing countriesA guide for planners and engineers. Crowthorne, UK: TRI; 1991.
5. Jacobs GD, Sayer IA. Road accidents in developing countries. Accident Analysis Prevent 1983;15:337-353.
6. World Health Organization. Road traffic accidents in developing countries, Geneva: World Health Organization, TRS; 1984:703.
7. Transport and Research Laboratories. Road safety in developing countries. Crowthorne, UK: TRL; 1990.
8. Hargarten SW, et al. Overseas fatalities of United States citizen travellers: An analysis of deaths related to international travellers. Ann Emerg Med 1991;20: 622-626.
9. Sniezek JE, Smith SM. Injury mortality among non-US residents in the United States 1979-1984. Internatl J Epidemiol 1991;19:225-229.
10. Prociv P. Deaths of Australian travellers overseas. Med J Austral 1995;163:27-30.
11. Paixao MLT, et al. What do Scots die of when abroad? Scottish Med J 1991;36:114-116.
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