Injury prevalence and safety habits of boda boda drivers in Moshi, Tanzania: A mixed methods study.
ABSTRACT: BACKGROUND:Traffic crashes are a major cause of global morbidity and mortality disproportionately affecting low- and middle-income countries (LMICs). Motorcycle taxi (boda boda) drivers are particularly vulnerable because they are exposed to traffic risks with limited safety equipment. This study aims to characterize injury prevalence and safety habits among boda boda drivers, as well as ways to improve road traffic safety in LMICs. METHODS:A cross-sectional mixed methods study was conducted with 300 boda boda drivers between 24 March and 3 April 2014 in urban Moshi, Tanzania. A convenience sample of participants was drawn from 25 of 58 registered boda boda stands and 2 of 31 unregistered stands. Data were analyzed using R, and content thematic analysis was performed and agreed upon by three investigators. Logistic regression models were used to evaluate the association between boda boda characteristics and injury risk. RESULTS:In total, 300 drivers participated, of whom 148 (49.3%) had experienced a crash during their lifetime, and 114 (77.0%) sustained at least one injury. Only 27 of those injured (23.4%) were hospitalized. Of all participants, 220 (73.3%) reported consistent helmet usage, despite 285 participants (95.0%) agreeing that helmet usage reduces injury severity. From the 280 helmets observed, 231 (82.5%) were either damaged or fit improperly. Having a cracked helmet was associated with higher risk of being involved in a traffic crash. Owning a helmet with a proper fit was associated with reduced risk for a traffic crash (OR = 0.06) and road traffic injuries (OR = 0.07). A thematic analysis of boda boda drivers' suggestions to increase road safety identified four intervention areas: 1) roadway infrastructure and traffic regulation, 2) road user attitudes and safe driving behaviors, 3) education and training, and 4) law enforcement. CONCLUSION:Our study demonstrates boda boda drivers' safety behaviors and identifies four intervention areas that can be leveraged to increase overall road traffic safety. Unfortunately, while boda boda drivers are aware of ways to improve safety, adherence to safety habits remains low. Successful multi-sectoral interventions are needed to improve road safety for boda boda drivers in Tanzania.
Project description:The 2013 World Health Organization Status Report on Road Safety estimated that approximately 1.24 million deaths occur annually due to road traffic crashes with most of the burden falling on low- and middle-income countries. The objective of this research is to study the prevalence of road traffic crashes in Mekelle, Tigray, Northern Ethiopia and to identify risk factors with the ultimate goal of informing prevention activities and policies.This study used a cross-sectional design to measure the prevalence and factors associated with road traffic crashes among 4-wheeled minibus (n = 130) and 3-wheeled Bajaj (n = 582) taxi drivers in Mekelle, Ethiopia. Bivariate and multivariate logistic regression were used to evaluate the association between risk factors and drivers' involvement in a road traffic crash within the 3 years prior to the survey.Among the 712 taxi drivers, 26.4% (n = 188) of them reported involvement in a road traffic crash within the past 3 years. Drivers who listened to mass media had decreased likelihood of road traffic crash involvement (AOR = 0.51, 0.33-0.78), while speedy driving (AOR = 4.57, 3.05-7.44), receipt of a prior traffic punishment (AOR = 4.57, 2.67-7.85), and driving a mechanically faulty taxi (AOR = 4.91, 2.81-8.61) were strongly associated with road traffic crash involvement. Receiving mobile phone calls while driving (AOR = 1.91, 1.24-2.92) and history of alcohol use (AOR = 1.51, 1.00-2.28) were also associated with higher odds of road traffic crash involvement.The results of this study show that taxi drivers in Mekelle habitually place themselves at increased risk of road traffic crashes by violating traffic laws, especially related to speedy driving, mobile phone use, and taxi maintenance. This research can be used to support re-evaluation of the type, severity, and enforcement of traffic violation penalties.
Project description: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.
Project description:PURPOSE:Various organizations and institutions are involved in road traffic injury (RTI) and crash registration such as police, forensic medicine organization, hospitals and emergency medical services. But there is a substantial uncertainty in interpreting the data, duplicated data collection and missing data in relation to RTI in most systems. This study aims to identify data sources for RTI surveillance in Iran and to explore traffic safety data source domains, data elements and detailed information by each data source. METHODS:This is a qualitative study which was conducted in 2017 in Iran. Data were collected employing semi-structured interviews with informants in road safety organizations in relation to traffic safety including Police, Ministry of Health and Medical Education as well as Forensic Medicine Organization and other authorities-in-charge. For completing the preliminary extraction information, the minimum data set was used and compared in each system. RESULTS:Eight different organizations relevant to road traffic safety were identified. The main domain of data provided by each one consists of Emergency Medical System form, Police KAM114 form, Ministry of Transport and Road Administration, Red Crescent Organization/Disaster Management Information System, Ministry of Health and Medical Education, Forensic Medicine Organization, Insurance Company and Ministry of Justice. Each system has its own database, based upon its scope and mainly at crash and post-crash status and little on pre-crash circumstance. CONCLUSION:All current registry systems are not surveillance systems for RTI prevention. Huge data have been collected in various registry systems in Iran, but most of the collected variables are duplicated in each system. On the other hand, some variables like alcohol and substance abuse, child seat belt, helmet use in relation to RTI prevention are missed in all systems. Accordingly, it is a critical need to integrate and establish a comprehensive surveillance system, with focus on the goal of each system and collection of minimum data in each organization, which currently is underway.
Project description:BACKGROUND: Both road safety campaigns and epidemiological research into social differences in road traffic injury risk often assume that road traffic injuries occur close to home. While previous work has examined distance from home to site of collision for child pedestrians in local areas, less is known about the geographic distribution of road traffic injuries from other modes. This study explores the distribution of the distance between home residence and collision site (crash distance) by mode of transport, geographic area, and social characteristics in England. METHODS: Using 10 years of road casualty data collected by the police, we examined the distribution of crash distance by age, sex, injury severity, area deprivation, urban/rural status, year, day of week, and, in London only, ethnic group. RESULTS: 54% of pedestrians, 39% of cyclists, 17% of powered two-wheeler riders and 16% of car occupants were injured within 1 km of home. 82% of pedestrians, 83% of cyclists, 54% of powered two-wheeler and 53% of car occupants were injured within 5 km of home. We found some social and geographic differences in crash distance: for all transport modes injuries tended to occur closer to home in more deprived or urban areas; younger and older pedestrians and cyclists were also injured closer to home. Crash distance appears to have increased over time for pedestrian, cyclist and car occupant injuries, but has decreased over time for powered two-wheeler injuries. CONCLUSIONS: Injuries from all travel modes tend to occur quite close to home, supporting assumptions made in epidemiological and road safety education literature. However, the trend for increasing crash distance and the social differences identified may have methodological implications for future epidemiological studies on social differences in injury risk.
Project description:The objective of this paper is to provide a new method for estimating crash rate and severity simultaneously.This study explores a Heckman selection model of the crash rate and severity simultaneously at different levels and a two-step procedure is used to investigate the crash rate and severity levels. The first step uses a probit regression model to determine the sample selection process, and the second step develops a multiple regression model to simultaneously evaluate the crash rate and severity for slight injury/kill or serious injury (KSI), respectively. The model uses 555 observations from 262 signalized intersections in the Hong Kong metropolitan area, integrated with information on the traffic flow, geometric road design, road environment, traffic control and any crashes that occurred during two years.The results of the proposed two-step Heckman selection model illustrate the necessity of different crash rates for different crash severity levels.A comparison with the existing approaches suggests that the Heckman selection model offers an efficient and convenient alternative method for evaluating the safety performance at signalized intersections.
Project description:Road traffic injury accounts for a substantial human and economic burden globally. Understanding risk factors contributing to fatal injuries is of paramount importance. In this study, we proposed a model that adopts a hybrid ensemble machine learning classifier structured from sequential minimal optimization and decision trees to identify risk factors contributing to fatal road injuries. The model was constructed, trained, tested, and validated using the Lebanese Road Accidents Platform (LRAP) database of 8482 road crash incidents, with fatality occurrence as the outcome variable. A sensitivity analysis was conducted to examine the influence of multiple factors on fatality occurrence. Seven out of the nine selected independent variables were significantly associated with fatality occurrence, namely, crash type, injury severity, spatial cluster-ID, and crash time (hour). Evidence gained from the model data analysis will be adopted by policymakers and key stakeholders to gain insights into major contributing factors associated with fatal road crashes and to translate knowledge into safety programs and enhanced road policies.
Project description:BACKGROUND:Traffic offences have been considered an important predictor of crash involvement, and have often been used as a proxy safety variable for crashes. However the association between crashes and offences has never been meta-analysed and the population effect size never established. Research is yet to determine the extent to which this relationship may be spuriously inflated through systematic measurement error, with obvious implications for researchers endeavouring to accurately identify salient factors predictive of crashes. METHODOLOGY AND PRINCIPAL FINDINGS:Studies yielding a correlation between crashes and traffic offences were collated and a meta-analysis of 144 effects drawn from 99 road safety studies conducted. Potential impact of factors such as age, time period, crash and offence rates, crash severity and data type, sourced from either self-report surveys or archival records, were considered and discussed. After weighting for sample size, an average correlation of r = .18 was observed over the mean time period of 3.2 years. Evidence emerged suggesting the strength of this correlation is decreasing over time. Stronger correlations between crashes and offences were generally found in studies involving younger drivers. Consistent with common method variance effects, a within country analysis found stronger effect sizes in self-reported data even controlling for crash mean. SIGNIFICANCE:The effectiveness of traffic offences as a proxy for crashes may be limited. Inclusion of elements such as independently validated crash and offence histories or accurate measures of exposure to the road would facilitate a better understanding of the factors that influence crash involvement.
Project description:BACKGROUND:The availability of prehospital trauma care is an important means of reducing serious injuries and fatalities associated with road traffic injuries (RTIs). Lay responders such as traffic police play an important role in the provision of prehospital trauma care to RTI victims, especially where there is no established prehospital care system. Therefore, the objective of the present study was to investigate knowledge, self-reported practice, and attitudes toward post-crash first aid among traffic police officers in Tanzania. METHOD:A cross-sectional survey was conducted in Dar es Salaam, Tanzania between July-September 2017 to investigate knowledge, self-reported practice and attitude among traffic police officers during provision of post-crash care. We used simple random technique to recruit 340 traffic police officers, self -administered questionnaires were used to collect data. The researchers used descriptive statistics and Pearson's chi-square tests to analyze the data. RESULTS:A total of 340 traffic police officers were surveyed. Nearly two thirds (65.3%) reported having had post-crash first aid on-the job training; a slightly larger proportion (70.9%) reported that they had cared for RTI victims in the previous year. The survey responses showed that, generally, traffic police officers' level of knowledge about post-crash first aid to RTI victims was low-about 3% of the surveyed officers possessed knowledge at a level considered good. Also, there was a statistically significant correlation between higher educational attainment and greater knowledgeability (p?=?0.015). Almost all of the officers (96%) had a positive attitude toward providing post-crash first aid to RTI victims. CONCLUSIONS:Improved training of Tanzania traffic police officers, by means of an updated post-crash first aid curriculum and updated resources is recommended. Also, user-friendly post-crash first aid leaflets should be provided to traffic police for their reference.
Project description:BACKGROUND:In Pacific Island countries and territories, the burden of road traffic injuries and their attendant risks are considered significant but are poorly quantified. As with other low and middle-income countries, understanding the epidemiology of road traffic injuries in Pacific countries is critical to informing sustainable research and policy initiatives aimed at reducing this burden. METHODS:We undertook a systematic review and critical appraisal of the relevant epidemiological literature between January 1980 and December 2010, using key search strings for incidence and aetiological studies focusing on RTIs in less resourced Pacific countries. RESULTS:Nineteen studies were identified. The majority were descriptive and were unable to provide population-based estimates of the burden of road crash injury, or reliable information on risk factors using well-designed aetiological research methods. All studies were published more than 10 years ago, and all but three reported on data from Papua New Guinea, thereby limiting the generalisability of findings to the current status in the region. Studies undertaken in Papua New Guinea suggested that RTIs were more frequent among young males, with head injuries the most common cause of death or hospital admission. Two thirds of fatalities occurred at the crash site or soon after admission. Most road crash victims were passengers or pedestrians. Factors postulated to influence the risk of RTIs were travel in open-back utility vehicles, utility vehicle overcrowding, and alcohol. CONCLUSIONS:This review suggests that, despite increasing awareness of the importance of addressing road safety among stakeholders in less resourced Pacific Island countries, road traffic injuries have not been a research priority with little relevant current evidence from the region to inform policy. Robust epidemiological research that can assess the magnitude and key determinants of road traffic injuries in these settings is essential to determine context-specific road safety initiatives that are relevant and affordable. Greater attention to harnessing routinely collected data (e.g., hospital information systems and police crash statistics) to inform policy is also required.
Project description:OBJECTIVE: To identify and estimate the population costs and effects of a selected set of enforcement strategies for reducing the burden of road traffic injuries in developing countries. DESIGN: Cost effectiveness analysis based on an epidemiological model. SETTING: Two epidemiologically defined World Health Organization sub-regions of the world: countries in sub-Saharan Africa with very high adult and high child mortality (AfrE); and countries in South East Asia with high adult and high child mortality (SearD). INTERVENTIONS: Enforcement of speed limits via mobile speed cameras; drink-drive legislation and enforcement via breath testing campaigns; legislation and primary enforcement of seatbelt use in cars; legislation and enforcement of helmet use by motorcyclists; legislation and enforcement of helmet use by bicyclists. MAIN OUTCOME MEASURES: Patterns of injury were fitted to a state transition model to determine the expected population level effects of intervention over a 10 year period, which were expressed in disability adjusted life years (DALYs) averted. Costs were expressed in international dollars ($Int) for the year 2005. RESULTS: The single most cost effective strategy varies by sub-region, but a combined intervention strategy that simultaneously enforces multiple road safety laws produces the most health gain for a given amount of investment. For example, the combined enforcement of speed limits, drink-driving laws, and motorcycle helmet use saves one DALY for a cost of $Int1000-3000 in the two sub-regions considered. CONCLUSIONS: The potential impact of available road safety measures is inextricably bound by the underlying distribution of road traffic injuries across different road user groups and risk factors. Combined enforcement strategies are expected to represent the most efficient way to reduce the burden of road traffic injuries, because they benefit from considerable synergies on the cost side while generating greater overall health gains.