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Purpose: Unintentional injury is the leading cause of death among children aged 10–19 years and over 95% of injury deaths occur in low- and middle-income countries (LMICs). As patterns of injury in the pediatric population may differ from those in adults, risks specific to children in LMICs need to be identified for effective injury prevention and treatment. This study explores patterns of pediatric injury epidemiology and cost in Yaoundé, Cameroon to inform injury prevention and resource allocation. Methods: Pediatric (age < 20 years) trauma patient data were collected at the emergency department (ED) of Central Hospital of Yaoundé (CHY) from April through October 2009. Univariate, bivariate, and multivariate analyses were used to explore injury patterns and relationships between variables. Regression analyses were conducted to identify predictors of receiving surgical care. Results: Children comprised 19% (544) of trauma cases. About 54% suffered road traffic injuries (RTIs), which mostly affected the limbs and pelvis (37.3%). Half the RTI victims were pedestrians. Transportation to CHY was primarily by taxi or bus (69.4%) and a preponderance (71.1%) of the severely and profoundly injured patients used this method of transport. Major or minor surgical intervention was necessary for 17.9% and 20.8% of patients, respectively. Patients with an estimated injury severity score ≥ 9 (33.2%) were more likely to need surgery (p < 0.01). The median ED cost of pediatric trauma care was USD12.71 [IQR 12.71, 23.30]. Conclusions: Injury is an important child health problem that requires adequate attention and funding. Policies, surgical capacity building, and health systems strengthening efforts are necessary to address the high burden of pediatric injuries in Cameroon. Pediatric injury prevention efforts in Cameroon should target pedestrian RTIs, falls, and burns and consider school-based interventions. [ABSTRACT FROM AUTHOR]

Road injuries are an important cause of global mortality especially in low- and middle-income countries. While these countries undergo major urban transformations, an integral part of their development has often been the implementation of mass transportation systems, including Bus Rapid Transit (BRT) systems. However, the net effect of BRT systems on road safety is still unclear, and while there is reason to believe that BRT systems improve safety, very few available empirical studies have tested this hypothesis using observational data. Furthermore, the existing evidence is mixed and sparse. This paper reviews the available literature on the links of BRT systems and road safety and calls for more research to strengthen the body of evidence on the effect of BRT systems on road safety  in the future. [ABSTRACT FROM AUTHOR]

Road traffic injuries (RTI) impose a substantial health burden among children. Globally, 186 300 children (under 18 years) die from RTI each year. It is the fourth leading cause of death among children aged 5-9 years, third among children aged 10-14 years and first among children aged 15-17 years. At the regional level, sub-Saharan Africa accounts for 35.2% of global child deaths caused by RTI; that number is still increasing. Male children are about two times more likely to die due to RTI than female children. RTI are also related to socioeconomic inequalities; low-income and middle-income countries (LMIC) account for 95% of global child RTI deaths, and children from poor households are more likely to fall victims to RTI. Intervention strategies promoted in the five pillars of the Decade of Action for Road Safety 2011-2020 are available to prevent mortality and morbidity caused by RTI, though validation and implementation of such interventions are urgently needed in the LMIC. Through concerted efforts to cultivate strong political will, build action and advocacy capacity, increase global funding and enhance multisectoral collaboration promoted by the Sustainable Development Goals, the world is challenged to do better in saving children from RTI. [ABSTRACT FROM AUTHOR]

Road traffic crashes have been an increasing threat to the wellbeing of road users worldwide; an unacceptably high number of people die or become disabled from them. While high-income countries have successfully implemented effective interventions to help reduce the burden of road traffic injuries (RTIs) in their countries, low- and middle-income countries (LMICs) have not yet achieved similar results. Both scientific research and capacity development have proven to be useful for preventing RTIs in high-income countries. In 1999, a group of leading researchers from different countries decided to join efforts to help promote research on RTIs and develop the capacity of professionals from LMICs. This translated into the creation of the Road Traffic Injuries Research Network (RTIRN) - a partnership of over 1,100 road safety professionals from 114 countries collaborating to facilitate reductions in the burden of RTIs in LMICs by identifying and promoting effective, evidenced-based interventions and supporting research capacity building in road safety research in LMICs. This article presents the work that RTIRN has done over more than a decade, including production of a dozen scientific papers, support of nearly 100 researchers, training of nearly 1,000 people and 35 scholarships granted to researchers from LMICs to attend world conferences, as well as lessons learnt and future challenges to maximize its work. [ABSTRACT FROM AUTHOR]

Introduction: Given the burden of road traffic injuries (RTIs) in South Africa, economic evaluations of prevention interventions are necessary for informing and prioritising public health planning and policy with regard to road safety. Methods: In view of the dearth of RTI cost analysis, and in order to understand the extent to which RTI-related costs in South Africa compare with those in other low- and middle-income countries (LMICs), we reviewed published economic evaluations of RTI-related prevention in LMICs. Results: Thirteen articles were identified, including cost-of-illness and cost-effectiveness studies. Although RTI-related risk factors in South Africa are well described, costing studies are limited. There is minimal information, most of which is not recent, with nothing at all on societal costs. Cost-effective interventions for RTIs in LMICs include bicycle and motorcycle helmet enforcement, traffic enforcement, and the construction of speed bumps. Discussion: Policy recommendations from studies conducted in LMICs suggest a number of cost-effective interventions for consideration in South Africa. They include speed bumps for pedestrian safety, strategically positioned speed cameras, traffic enforcement such as the monitoring of seatbelt use, and breathalyzer interventions. However, interventions introduced in South Africa will need to be based either on South African cost-effectiveness data or on findings adapted from similar middle-income country settings. [ABSTRACT FROM AUTHOR]

Motorcycle use as a functional and recreational means of transportation is increasing in Mexico; the associated mortality rate has also increased. Appropriate helmet use can reduce a motorcyclist's risk of death or serious injury. This study quantified the prevalence of motorcycle helmet use in three Mexican cities (Cuernavaca, Guadalajara-Zapopan, and León) within the context of several ongoing road safety initiatives. Four rounds of roadside observations were conducted between November 2010 and April 2012. The overall prevalence of helmet use was 73.8% among all users; helmet use was much lower among females (55.3%). Drivers tended to use helmets more frequently than passengers (76.3% vs. 51.6%). The prevalence was higher in León (85.9%, 95% CI = 84.8–87.0) than Cuernavaca (71.5%, 95% CI = 69.3–73.6) and Guadalajara-Zapopan (62.7%, 95% CI = 61.1–64.2). Helmet use decreased in León (p= 0.003) but increased in Guadalajara-Zapopan (p= 0.000) during this period. Motorcycle helmet use could be improved in all three cities. Since motorcycle use is increasing, interventions targeting motorcycle users and greater enforcement of helmet use are necessary to reduce crashes and non-fatal and fatal injuries. [ABSTRACT FROM PUBLISHER]

Context Currently, little is known about rates of death by cause and country among US travellers. Understanding the risk by cause and country is imperative to risk communication and the development of risk reduction strategies. Methods Publicly available data on non-natural deaths of US citizens abroad were gathered from January 2003 to December 2009 from the US Department of State’s Department Bureau of Consular Affairs. Traveller information was gathered from the US Department of Commerce Office of Travel and Tourism for the same time period. Rates of death were calculated by dividing the number of non-natural deaths of US citizens abroad by the number of US outbound visits for each country. Results A total of 5417 non-natural death events were retrieved between 2003 and 2009 from the US State Department. Intentionally caused death rates ranged from 21.44 per 1 000 000 visits in the Philippines to 0 per 1 000 000 visits in several countries; the majority of countries had fewer than five intentionally caused deaths per 1 000 000 visits. Rates of road traffic crashes were higher than rates of intentionally caused deaths in almost every instance. Thailand had the highest rate of deaths due to road traffic crashes (16.49 per 1 000 000), followed by Vietnam, Morocco and South Africa (15.12 per 1 000 000, 11.96 per 1 000 000 and 10.90 per 1 000 000, respectively). Motorcycle deaths account for most of the heightened risk observed in Thailand and Vietnam. Conclusions The leading cause of non-natural deaths in US travellers abroad was road crashes, which exceeds intentional injury as the leading cause of non-natural deaths in almost every country where US citizens travel. Southeast Asia had the highest unintentional injury death rates for US citizens abroad due to the high rates of deaths from motorcycle crashes. [ABSTRACT FROM AUTHOR]

Objectives. We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middleincome countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan). Methods. We collected standardized data from children ages 0 to 12 years at participating emergency departments (EDs) in 2007. Statistical analyses were conducted to compare the characteristics of these injuries and to explore the determinants of injury outcomes. Results. Among 2686 injured children, falls (50.4%) and road traffic injuries (16.4%) were the most common, affecting boys more often (64.7%). Home injuries were more common among younger children (average 5.41 vs 7.06 years) and girls (38.2% vs 31.7%). Following an ED visit, 24% of injured children were admitted to the hospital, and 6 died. Injury outcomes were associated with risk factors, such as age and sex, to varying extents. Conclusions. Standardized ED surveillance revealed unintentional injuries are a threat to child health. The majority of events took place inside the home, challenging traditional concepts of children's safety and underscoring the need for intensified context-appropriate injury prevention. [ABSTRACT FROM AUTHOR]

Context: While road traffic mortality has been reported to be seriously undercounted by the police in China, non–police-reported data have not been explored previously to examine vulnerable road user mortality. Objective: To examine changes in bicyclist mortality between 2006 and 2010 in China, using the Disease Surveillance Points (DSP) data of China. Design, setting and data source: Mortality data of 2006–2010 from DSP data, covering 73 million population, was analysed. Poisson regression was used to examine the significance of year after controlling for sex, age and urban/rural location. Main outcome measure(s): Mortality rate and mortality rate ratio (MRR). Results: Between 2006 and 2010, the mortality rate for bicyclists increased from 1.1 to 1.6 per 100 000 population according to DSP data. Between 2006 and 2010, more than 90% of bicyclist deaths were undercounted by the police compared to the findings from DSP data. Contrary to the 34% increase between 2006 and 2010 reflected by DSP data (adjusted MRR: 1.34, 95% CI 1.23 to 1.46), police data revealed a 64% decrease in bicyclist mortality (unadjusted MRR: 0.36, 95% CI 0.32 to 0.40) in the study time period. Conclusions Health data should be used to assess the road traffic injuries in China. The recent increase in bicyclist mortality merits attention from policy makers and researchers. [ABSTRACT FROM AUTHOR]

Among 1-19-year olds, unintentional injuries accounted for 12% of 5.1 million global deaths from injuries in 2010. Despite this high burden, childhood injuries have not received much attention in global health. This paper describes the major causes of deaths from childhood unintentional injuries and provides a review of interventions for reducing this burden. About 627 741 deaths were due to unintentional injuries in 2010 among 1-19-year olds. The proportionate mortality increased with age--from 12.6% among 1-4-year olds to 28.8% among 15-19-year olds. Deaths from Western sub-Saharan Africa and South Asia accounted for more than 50% of all deaths. Rates in these regions are 68.0 and 36.4 per 100 000 population, respectively, compared to 6.4 in Western Europe. Road traffic injuries (RTI) are the commonest cause of death, followed by deaths from drowning, burns and falls. Male children are more predisposed to unintentional injuries except for burns which occur more frequently among females in low and middle income countries (LMICs). Effective solutions exist--including barriers for preventing drowning; safer stoves for burns; child restraint systems for RTI--but the effectiveness of these measures need to be rigorously tested in LMICs. The general lack of a coordinated global response to the burden of childhood unintentional injuries is of concern. The global community must create stronger coalitions and national or local plans for action. Death rates for this paper may have been underestimated, and there is need for longitudinal studies to accurately measure the impact of injuries in LMICs. [ABSTRACT FROM AUTHOR]

The article presents a study on the prevalence of distracted driving and road traffic injury (RTI) caused by mobile phone use while driving (MPUWD) in Mexico. It measures this prevalence among drivers in three Mexican cities and identifies associated demographic and environmental factors. The study, which was conducted from roadside observations of randomly selected automobile drivers between 2011-12, showed the importance of designing preventive interventions to address the MPUWD problem.

The author analyzes the pre-travel consultation conducted on travelers. He believes that travel consultation can play an important role in injury prevention. He states that a pre-travel consultation should include an assessment to identify potential risks at the travel site and from travel itself. The top 20 countries with the highest number of road traffic deaths are cited, which include China, India and Nigeria.

The road traffic crash burden is significant in Brazil; calculating years of life lost and life expectancy reduction quantifies the burden of road traffic deaths to enable prioritization of this issue. Years of life lost and reduction in life expectancy were calculated using 2008 population/crash data from Brazil's ministries of health and transport. The potential for reduction in crash mortality was calculated for hypothetical scenarios reducing death rates to those of the best-performing region and age category. In Brazil, road traffic deaths reduce the at-birth life expectancy by 0.8 years for males and by 0.2 years for females. Many years of life lost for men and woman could be averted--270,733 and 123,986, respectively--if all rates matched those of the lowest-risk region and age category. This study further characterizes the burden of motor vehicle deaths in Brazil and quantifies the potential health benefits of policies/interventions that reduce road traffic death rates to those of the best-performing subpopulations. [ABSTRACT FROM AUTHOR]

Background: This article highlights the epidemiology of road traffic injury (RTI) in Lithuania between 1998 and 2007. The purpose of this study is to explore the incidence of RTI, age-standardized mortality rates (ASMR), gender-specific rates and the RTI profile of different user groups. In doing so, this analysis attempts to emphasize the need for RTI prevention policies and programmes. Methods: Six databases were analysed using ICD-10 codes V01–V99, pertaining to the causes of road traffic crashes. Data between 1998 and 2007 were obtained from these databases to identify and calculate RTI incidence and mortality rates. This was then analysed with regard to ASMR, gender, user groups and the use of alcohol. Results: In 2007, RTI incidence in Lithuania was reported as 270/100 000 people, 10.7% higher than in 1998. ASMR declined from 28 deaths per 100 000 in 1998 to 25 deaths per 100 000 in 2007. Between 1998 and 2007, the male ASMR declined from 46 to 40 deaths per 100 000 and the female ASMR decreased from 13 to 11 deaths per 100 000. Car occupant and pedestrian fatalities comprised 87% of all RTI deaths. Thirty-four percent of those injured and 21% of the dead were under influence of alcohol. Conclusions: From 1998 to 2007, the incidence of RTI has worsened and mortality rates remain high in Lithuania. Alcohol remains a prominent risk factor of traffic injury and death. The need to develop effective prevention programmes to address traffic injury is essential. [ABSTRACT FROM AUTHOR]

Background Road traffic injuries (RTIs) are increasingly contributing to the burden of disease in sub-Saharan Africa, yet little is known about the economic consequences and disability associated with them. Objective To explore cost and disability consequences of RTIs in Nigeria. Design A population-based survey using two-stage stratified cluster sampling. Subject/setting Information on care-seeking choice, cost of treatment, ability to work, reduction in earnings, and disability were collected on 127 subjects who had suffered an RTI, of 3082 study subjects in seven Nigerian states. Outcome measures Univariate analysis was used to estimate frequency of disability, types of care sought, and trends for work lost, functional ability and cost of treatment. Unadjusted bivariate analysis was performed to explore care-seeking, cost of care, and work lost among disabled and non-disabled people. Results RTIs resulted in disability for 29.1% of subjects, while 13.5% were unable to return to work. Of the disabled people, 67.6% were unable to perform activities of daily living, 16.7% consequently lost their jobs, and 88.6% had a reduction in earnings. Private physician and hospital treatment were the most common forms of initial treatment sought, but traditional treatment was the most common second form of care sought. Average direct costs of informal and formal treatment were US$6.65 and US$35.64, respectively. Disabled people were more likely to seek formal care (p=0.003) and be unable to work (p=0.002). Conclusions Economic and functional ramifications must be included in the spectrum of consequences of RTIs to fully appreciate the extent of the burden of disease, implying that health systems should not only address the clinical consequences of RTIs, but the financial ones as well. [ABSTRACT FROM AUTHOR]

Aims: The overall goal of this paper is to highlight the epidemiology of injury in Lithuania between 1998 and 2006. Such a situation analysis will inform the important dialogue happening in Lithuania with respect to renewal of the trauma programme and help to profile the burden of injury in the country. Methods: Review of the literature, and secondary analysis of data from the Lithuanian Health Information Center and the European Detailed Mortality database. Results: Sixteen articles were identified as population-based studies; only incidence of burn injuries was reported as 240 per 100,000 per year. According to our analysis, the overall incidence of injury increased from 76 cases per 1,000 individuals in 1998 to 121 cases per 1,000 individuals in 2006. The total number of deaths from external causes remained similar with an average of 5,301 per year, as did the age-standardized mortality rates of 152 in 1998 and 150 per 100,000 in 2006. The mortality rate in men was four times higher than in women. Suicide was the most frequent cause of death (34% in 2006); while road traffic injuries were the second most frequent accounting for 17-19% of deaths. There were 429 deaths due to exposure to natural cold in 2006, which constituted 8% of all deaths due to injury. Conclusions: Injury incidence and mortality from external causes in Lithuania has not declined over an eight year time frame. New efforts should be launched in the health sector to address this major cause of deaths. [ABSTRACT FROM AUTHOR]

Objectives. To better understand national data sources and evaluate time trends in road traffic fatalities (RTF) in China. Methods. We reviewed national sources on RTF data. These included population-based report from the Ministry of Public Security (MPS), sample-based estimates from the Ministry of Health (MOH) and the Disease Surveillance Points System (DSP), as well as model-based estimates from the World Health Organization (WHO), and the Global Burden of Disease Study (GBD). Results. All data sources have limitations in coverage, representativeness or overreliance on model specifications. Despite the discrepancies in methodologies and estimates, all sources indicated an increase in RTF before 2005. Since then, MPS and GBD indicated a decrease, DSP showed plateauing, and MOH and WHO suggested increasing fatalities. However, despite any recent decline, RTF remain high. Conclusions. The divergent trends in RTF across data sets in China implies a challenge to understanding China's experience with addressing RTF. China needs to reconcile data sources and further improve road safety. [ABSTRACT FROM AUTHOR]

Background: Road traffic injuries (RTI) are a major cause of mortality and disability in the world. Only after significant losses have communities in developed nations taken necessary steps to prevent crashes and their consequences. Increase in road safety is related to increasing socio-economic development. We aim to study the trends in injury and death rates in a developing country, India, define sub-national variations, and analyse these trends in relation to economic and population growth. Methods: Public sector data from India were used to develop a standardized database on traffic injuries and indicator of economic development. The data were analysed using linear regression models to test the a priori hypothesis of a positive relationship between net domestic product (NDP), and injury and death rates from road crashes across states. Results: The absolute burden of RTI in India has been consistently rising over the past three decades. The reported rates are lower than those estimated by global health agencies and may reflect under-reporting. Population-based rates provide a better assessment of the public health burden of RTI than vehicle-based rates. There is an inverted U-shaped relationship between NDP and injury and death rates. Even with the limited data, Kuznets phenomenon is evident for within-country level comparisons. Conclusions: India and other developing countries could learn from the experience of highly motorized nations to avoid the expected rise in RTI and deaths with economic development, by currently investing in road safety and prevention measures. [ABSTRACT FROM AUTHOR]

Aims: India is the largest country in the South Asian region with all the problems faced by rapidly developing nations, especially increasing motorization. In spite of such developments, there are limited data in the literature addressing the problem of road traffic injuries. This article is an attempt to estimate the magnitude of the problem through published literature. Methods: This article is a systematic review of the literature on road traffic injuries in India, conducted using three electronic databases and hand-searching of the selected articles. Final analyses were conducted with 22 studies. Results: Road traffic injuries are a significant burden on the health care system in India. The most commonly affected group is young males. Pedestrians constitute a large majority of the victims and there is high early mortality in most cases. Conclusions: There is lack of population-based data on road traffic injuries in India and there is large heterogeneity in the published data. This is an important research agenda for the country. Immediate steps are required to curb this problem to limit the loss of life and resources. [ABSTRACT FROM AUTHOR]

To assess the burden of road traffic injuries in Pakistan—a developing country in South Asia. A nationally representative household interview survey, to measure the burden of all injuries for all ages and in both genders using a three-month recall period. The overall incidence of injury events was 41 (CI: 39.2–43.8) per 1000 per year and for road traffic injuries 15 (CI: 13.7–16.5) per 1000 per year. The relative risk for road traffic injuries was found to be higher in males, those 16–45 years old, and those in the professional category of laborers and vendors. This first national survey reflects the growing impact of injuries, especially road traffic injuries in Pakistan and portends a challenge for the national health system. [ABSTRACT FROM AUTHOR]

The author reflects on millennium development goal 4 which seeks to decrease mortality in children whose ages are under 5 years by two-thirds between 1990 and 2015. He notes that only 10 of the 67 countries with high child mortality will meet the target. The failure to meet the target is attributed to the lack of focus on prevention of childhood injury in many countries. He expresses his surprise to the relative lack of global attention to childhood injuries in terms of public policies and resource investment.

Comments on the effort of the World Health Organization on global public health in the field of road traffic injuries. Conduction of major events to promote action for saving lives and preventing morbidity; Theme of the World Health Day; Discussion of road safety by the United Nations General Assembly.

The article offers information on the progress made by the project that was funded by Bloomberg Philanthropies for carrying out road safety activities in ten countries including India, China, Egypt, Kenya, Mexico and Russia. The survey by Johns Hopkins International Injury Research Unit discusses the formation of new laws by countries like Brazil, India and China. Better enforcement and increased population reach are some of the main benefits caused by the project.

Over 90% of the annual 1·35 million worldwide deaths due to road traffic injuries (RTIs) occur in low-income and middle-income countries (LMICs). For this Series paper, our aim was two-fold. Firstly, to review evidence on effective interventions for victims of RTIs; and secondly, to estimate the potential number of lives saved by effective trauma care systems and clinical interventions in LMICs. We reviewed all the literature on trauma-related health systems and clinical interventions published during the past 20 years using MEDLINE, Embase, and Web of Science. We included studies in which mortality was the primary outcome and excluded studies in which trauma other than RTIs was the predominant injury. We used data from the Global Status Report on Road Safety 2018 and a Monte Carlo simulation technique to estimate the potential annual attributable number of lives saved in LMICs. Of the 1921 studies identified for our review of the literature, 62 (3·2%) met the inclusion criteria. Only 28 (1·5%) had data to calculate relative risk. We found that more than 200 000 lives per year can be saved globally with the implementation of a complete trauma system with 100% coverage in LMICs. Partial system improvements such as establishing trauma centres (>145 000 lives saved) and instituting and improving trauma teams (>115 000) were also effective. Emergency medical services had a wide range of effects on mortality, from increasing mortality to saving lives (>200 000 excess deaths to >200 000 lives saved per year). For clinical interventions, damage control resuscitation (>60 000 lives saved per year) and institution of interventional radiology (>50 000 lives saved per year) were the most effective interventions. On the basis of the scarce evidence available, a few key interventions have been identified to provide guidance to policy makers and clinicians on evidence-based interventions that can reduce deaths due to RTIs in LMICs. We also highlight important gaps in knowledge on the effects of other interventions. [ABSTRACT FROM AUTHOR]

Introduction: Injury is a significant and increasingly common cause of morbidity and mortality in sub-Saharan Africa; however, the social and economic factors underlying these trends are not well understood. We evaluated the relationship between socioeconomic status (SES) and trauma outcomes using a prospective registry of patients presenting to the largest trauma hospital in Yaoundé, Cameroon.Methods: Trauma patients (n=2855) presenting to the emergency ward at Central Hospital, Yaoundé between April 15 and October 15, 2009 were surveyed regarding demographic and socioeconomic background, nature and severity of injuries, treatment, and disposition. A wealth score was estimated for each patient, corresponding to an SES index constructed using principle components analysis of the urban Cameroonian Demographic and Health Survey. Logistic regression was used to evaluate the effects of SES on care-seeking behaviour, injury severity, and treatment outcome.Main Outcome Measures: SES wealth score, care-seeking prior to visiting hospital, injury severity, treatment outcome.Results: Patients aged 1-89 presented with road traffic injuries (59.83%), falls (7.76%), and penetrating trauma (6.16%), and had higher SES than the broader urban Cameroonian population. Within the Yaoundé sample, being in the lowest SES quintile was associated with an increased likelihood of having sought care elsewhere before presenting to the hospital (aOR=3.28, p<0.001), after controlling for background and injury characteristics. Patients in the lowest SES quintile were also more likely to present with moderate/severe injuries (aOR=4.93, p<0.001), and were more likely to be transferred to the operating room.Conclusions: Patients presenting to this trauma centre were wealthier than the broader community, suggesting the possibility of barriers to accessing care. Poorer patients were more likely to have severe injuries and more likely to need surgery, but were less likely to seek care from a major trauma centre immediately. Substantial differences in SES between the sample visiting the hospital and the broader community suggest a need for community-based sampling approaches in future trauma research. [ABSTRACT FROM AUTHOR]

Introduction: Each year in India, road traffic crashes lead to more than 200,000 deaths and the country has seen an unprecedented rate of roadway fatalities in recent years. At the same time, alcohol consumption per capita among Indians is rising. Despite these increasing trends of road traffic injuries (RTIs) and alcohol use, alcohol is not routinely assessed as a risk factor for RTIs. This study aims to examine the involvement of alcohol among emergency department patients presenting with RTIs in the Indian city of Hyderabad.Patients and Methods: As part of a prospective study, data were collected from 3366 patients (88.0% male) presenting with RTIs at an emergency department in Hyderabad, India, from September 2013 to February 2014. Logistic regression models were used to assess individual-level and road traffic crash characteristics associated with suspected or reported alcohol consumption six hours prior to the RTI.Results: Alcohol was suspected or reported among 17.9% of the patients with RTIs. Adjusting for confounders, males experienced 9.8 times greater odds of alcohol-related RTIs than females. Compared to 15-24 year-olds, the odds of alcohol consumption was 1.4 times greater among 25-34 year-olds and 1.7 times greater among 35-44 year-olds, adjusting for confounding factors. Patients who were passengers in vehicles other than motorized two-wheelers had 90% reduced odds of an alcohol-related RTI than motorized two-wheeler drivers. Drivers of non-two-wheelers, passengers on two-wheelers, and pedestrians did not have significantly different odds of an alcohol-related RTI compared to two-wheeler drivers. Nighttime crashes were associated with nearly a threefold increase in the odds of alcohol consumption.Conclusions: Given that alcohol was suspected or reported in more than one in six injured ED patients with RTIs, it is clear that alcohol is a serious risk factor for RTIs; this evidence can guide prevention efforts. These findings suggest that evidence-based interventions to reduce drink-driving, such as random breath testing (where law enforcement officials stop drivers on the road to test them for alcohol use), could be more widespread in India. Future studies should assess the effectiveness of greater implementation and enforcement of policies to decrease alcohol's availability to reduce RTIs. [ABSTRACT FROM AUTHOR]

Background Road traffic injuries (RTIs) are a major cause of death and disability worldwide. In Cameroon, like the rest of sub-Saharan Africa, more data on RTI patterns and outcomes are needed to improve treatment and prevention. This study analyses RTIs seen in the emergency room of the busiest trauma centre in Yaoundé, Cameroon. Methods A prospective injury surveillance study was conducted in the emergency room of the Central Hospital of Yaoundé from April 15 to October 15, 2009. RTI patterns and relationships among demographic variables, road collision characteristics, injury severity, and outcomes were identified. Results A total of 1686 RTI victims were enrolled. The mean age was 31 years, and 73% were male. Eighty-eight percent of road collisions occurred on paved roads. The most common user categories were ‘pedestrian’ (34%) and ‘motorcyclist’ (29%). Pedestrians were more likely to be female ( p < 0.001), while motorcyclists were more likely to be male ( p < 0.001). Injuries most commonly involved the pelvis and extremities (43%). Motorcyclists were more likely than other road users to have serious injuries (RR = 1.45; 95% CI: 1.25, 1.68). RTI victims of lower economic status were more likely to die than those of higher economic status. Discussion Vulnerable road users represent the majority of RTI victims in this surveillance study. The burden of RTI on hospitals in Cameroon is high and likely to increase. Data on RTI victims who present to trauma centres in low- and middle-income countries are essential to improving treatment and prevention. [ABSTRACT FROM AUTHOR]

In settings with low seatbelt use prevalence, self-reported seatbelt use estimates often lack validity, and routine observational studies are scarce. In this paper, we aim to describe the prevalence of seatbelt use and associated factors in drivers and front-seat passengers across eight sites in four countries (Egypt, Mexico, Russia, Turkey) using observational studies as well as to produce estimates of country-level and site-level variance. As part of the Bloomberg Philanthropies Global Road Safety Program, data on driver and passenger seatbelt use across four middle-income countries was collected between October 2010 and May 2011 (n = 122,931 vehicles). Logistic regression and Intraclass Correlation Coefficient analyses for sites- and country-level clustering were performed. We found high variability of seatbelt wearing rates ranging from 4 to 72% in drivers and 3-50% in front-seat passengers. Overall, average seatbelt wearing rates were low (under 60% in most sites). At the individual level, older and female drivers were more likely to wear seatbelts, as well as drivers of vehicles transiting at times of increased vehicle flow. We also found that 26-32% and 37-41% of the variance in seatbelt use among drivers and front-seat passengers respectively was explained by differences across sites and countries. Our results demonstrate that there is room for improvement on seatbelt use in middle-income countries and that standardized cross-country studies on road safety risk factors are feasible, providing valuable information for prevention and monitoring activities. [ABSTRACT FROM AUTHOR]

Road traffic injury (RTI) is the leading cause of death in persons aged 10-24 worldwide and accounts for about 15% of all male deaths. The burden of RTI is unevenly distributed amongst countries with over eighty-fold differences between the highest and lowest death rates. Thus the unequal risk of RTI occurring in the developing world, due to many reasons, including but not limited to rapid motorization and poor infrastructure, is a major global challenge. This editorial highlights a number of key issues that must inform programs designed to prevent RTI in the developing world, where the epidemic is all the more insidious. firstly, road safety is a development issue; secondly, road traffic injury is a major health issue; thirdly, road traffic injuries can be prevented by the implementation of scientific measures; fourthly, pre-hospital and hospital emergency care is needed; and fifthly, research on RTI is neglected in low-income and middle-income countries. The repercussion of such progress to Peru is also discussed. [ABSTRACT FROM AUTHOR]

Objective Road traffic injuries pose a significant threat to the Egyptian population. Recent estimates revealed that Egypt experiences 42 road traffic deaths per 100,000 population (1.8% of all deaths in the country), which is the highest death rate in the region. More than half of the road traffic crashes that resulted in injuries occurred on the country's highways. Despite the significance of this public health problem, very little risk factor information currently exists. The overall goal of this paper is to understand the burden of speeding and the level of seatbelt and child restraint use on a highway (Cairo Ring Road) and two urban roads crossing Alexandria city (Kornish and Gamal Abd-Elnaser roads). Methods Two rounds of seatbelt and child restraint observational studies and one round of speed observational study were carried out between 2011 and 2012. Results Findings revealed that seatbelt use among drivers and front seat passengers were low for all three sites (range: 11.1% to 19.8% for drivers; 2.9% to 4.0% for front seat passengers). Similarly, child restraint use in cars with children was very low ranging from 1.1% to 3.9% on all three roads. All three roads experienced a high percentage of vehicles driving above the speed limit (39.4% on Kornish Road, 22.6% on Cairo Ring Road, 11.8% on Gamal Abd Elnaser Road), with the majority of these vehicles driving 1 to 10 kilometer above the speed limit. Conclusion Future interventions need to focus on enhancing enforcement of speed and seatbelt wearing, closing gaps in legislation, and standardizing existing data systems to help inform good road safety policies. [ABSTRACT FROM AUTHOR]

Objective In Russia, the high Road Traffic Injuries (RTIs) rate has been attributed to two well-known risk factors – the low rates of seatbelt and child restraints use and speeding. Despite the importance of understanding both speeding and seatbelt use patterns for the purpose of direct interventions or monitoring road safety situation, no study has assessed the current status of speeding among all vehicles and seatbelt wearing rates among all vehicle occupants in Russia. We are aware that alcohol is a known risk factor for RTI in the country however the work focused on seat belts and speed. This research was conducted as part of the Bloomberg Philanthropies Global Road Safety Programme and focuses on observed speeding and seatbelt use in two Russian regions: Lipetskaya and Ivanovskaya Oblast. Methods Data was collected through observational surveys on selected roads in the two interventions sites (Lipetskaya and Ivanovskaya Oblast) between October 2010 and March 2013. The percentage of seatbelt use by drivers and passengers and the percentage of speeding vehicles by speed limit and road types were calculated. Results Observational studies on speeding show signs that drivers are speeding less from the first survey held in July 2011 in Lipetskaya Oblast and March 2012 in Ivanovksya Oblast. Overall the observational studies showed a consistent reduction in the proportion of vehicles exceeding the speed limit: from 54.7% (2012) to 40.1% (2013) in Ivanovskaya Oblast and from 47.0% (2011) to 26.1% (2013) in Lipetskaya Oblast. Observational studies on seatbelt use demonstrate an increase in seatbelt wearing rates from the first survey held in October 2010 in Lipetskaya Oblast and April 2011 in Ivanovskaya Oblast. The overall prevalence of seatbelt use increased from 52.4% (2010) to 73.5% (2013) amongst all occupants in Lipetskaya Oblast and from 47.5% (2011) to 88.8% (2013) in Ivanovskaya Oblast. Conclusion Preliminary results show some promising signs that speeding and seatbelt use are moving in the right direction in both intervention sites subsequent to the various countermeasures being implemented under the Global Road Safety Programme. The study demonstrates the need for further targeted interventions to increase drivers' compliance with the speed limit and seatbelt use. However, it is too early to draw any definite conclusions or to fully attribute the effect to the interventions. [ABSTRACT FROM AUTHOR]

Objective Viet Nam is experiencing a shift in its burden of disease profile with injuries becoming more prominent. A history of high alcohol involvement in road traffic crashes despite stringent laws led to increased enforcement by police, enhanced public education messaging and targeted social marketing campaigns in Ha Nam and Ninh Binh provinces in Viet Nam. This study aims to illustrate the changes in prevalence (November 2010 to December 2011) and knowledge, attitudes and practices (KAP) around alcohol use and drink-driving for the year 2011. Methods Breath Alcohol Concentration (BrAC) was collected through police enforcement checkpoints in the two provinces. The proportion of drivers with BrAC above the legal limit was plotted over time for both provinces. The trend in prevalence of drink-driving over time was further assessed using Poisson regression models. Prevailing KAPs were determined through surveying randomly selected road users over the age of 17 years at gas stations at quarterly intervals. Cross tabulations of key variables as well Chi-Square statistic were used to assess associations. Results A total of 8,404 drivers were tested for BrAC levels of which less than 0.25% were female. Of 1,639 drivers displaying BrAC levels in excess of the legal limit, 87.3% were car drivers, 7.9% motorcyclists and 86% were between the ages of 25 and 44 years. KAP surveys captured 1,661 drivers over the study period. The prevalence of self-reported drink-driving increased 6 percentage points among respondents aged 27–36. Between 44% (January 2011) and 49% (December 2011) of respondents indicated awareness of a drinking and driving Blood Alcohol Concentration (BAC) or BrAC limit and only 25% of all study participants recalled being penalized for a traffic violation – none of which were for drink-driving. Conclusion While there has been some reduction in drink-driving prevalence, inadequate or incorrect knowledge on drink-driving legislation appears to be an impediment to greater gains. Increased attention needs to be paid to enforcement activities and social marketing campaigns need to be part of a multi-faceted programme that also works on improving existing legislation, takes into consideration gender issues, and enhances visible enforcement of the laws. [ABSTRACT FROM AUTHOR]

Road traffic crashes in China kill in excess of 250,000 people annually, more than any other country in the world. They are the fourth leading cause of premature death in the country and are responsible for 2.4% of the burden of non-fatal health loss in the country. Interventions to curb speeding and drink driving are being implemented in the cities of Suzhou and Dalian since late 2010. We evaluated the ongoing effect of these activities through five roadside surveys, seven rounds of observational studies, and analysis of crash statistics in the two cities. We find that thus far, the prevalence of speeding has not reduced in either city with the notable exception of one site in Dalian, where the percentage of speeding vehicles declined from nearly 70% to below 10% after an interval-based speed enforcement system was installed. The broader deployment of such speed control technologies across China and other countries should be explored. Roadside alcohol testing suggests that prevalence of drink driving prevalence (i.e. BAC >20 mg%) declined from 6.4% to 0.5% in Suzhou and from 1.7% to 0.7% in Dalian during the monitored time period. However, the measured prevalence rates are very low and should be validated against estimates based on hospital studies. Roadside interviews suggest that the population of both cities is already highly sensitized to the risks associated with drink driving and speeding. Crash statistics from the two cities do not show appreciable declines in injuries and fatalities as yet. However, the possibility of substantial underreporting in crash statistics sourced from traffic police poses a severe threat to monitoring progress towards road safety in Suzhou, Dalian and across China. There is an urgent need for China to invest in a reliable road traffic injury surveillance system that can provide information for describing key risk factors, evaluating the impact of safety policies, and benchmarking achievements. [ABSTRACT FROM AUTHOR]

Introduction In Kenya, RTIs had the second highest increase in disability-adjusted life years between 1990 and 2010, compared to other conditions. This study aims to determine the prevalence, knowledge, attitudes and practices for speeding in Thika and Naivasha districts in Kenya. Methods Direct observations of vehicle speed were conducted at various times during the day and different days of the week on six roads selected based on a multi-stage sampling method in two districts to determine the prevalence of speeding. Roadside KAP interviews were administered to drivers, at motorcycle bays, petrol stations, and rest areas. Results Eight rounds of speed observations and four rounds of KAP interviews were conducted between July 2010 and November 2012. Results from the speeding observational studies show an overall high proportion of vehicles speeding above posted limits in both districts, with an average of 46.8% in Thika and 40.2% in Naivasha. Trend analysis revealed a greater decline in this prevalence in Thika (OR: 0.804, 95% CI: 0.793–0.814) than in Naivasha (OR: 0.932, 95% CI: 0.919–0.945) over the study period. On average, 58.8% of speeding vehicles in Thika and 57.2% of speeding vehicles in Naivasha travelled at 10 km/h or higher above speed limit. While the majority of respondents agreed that speeding is a cause of road traffic crashes in both Thika (70.3%) and Naivasha (68.7%), knowledge of speed limits at the location of the interview was limited. Enforcement levels also remained low, but subsequent rounds of data collection showed improvement, especially in Thika. Conclusions This study demonstrates an improvement in the prevalence of speeding in two districts of Kenya over 2010–2012. It also highlights the need for further action to be taken to address the problem, and represents new data on speeding in Kenya and Africa. [ABSTRACT FROM AUTHOR]