Special report on road traffic injury prevention

Road traffic injuries are a major cause of death and disability in the developing world, and the toll is forecast to rise over the next two decades as societies become more motorised, says the World Health Organisation (WHO). Although it has fewer cars on the road, Africa leads the world in deaths from traffic injuries - an indication of the poor safety standards of motorists, their vehicles, the transport network, and the limitations of the health system. In economic terms, the cost of crash injuries is estimated at roughly 1.0 percent of gross national product (GNP) for low-income countries. In the case of Malawi and South Africa's KwaZulu-Natal province, studies indicate that the cost could be as high as 5.0 percent of GNP. A PUBLIC HEALTH ISSUE Despite the carnage and the toll taken on national resources, preventing traffic-related injury is rarely regarded as a public health issue. Rather than being seen as an inevitable price of "modernisation", there is an "urgent need to recognise the worsening situation in road deaths and injuries, and to take appropriate action. Road traffic injury prevention and mitigation should be given the same attention and scale of resources that is currently paid to other prominent health issues," noted the 'World Report on Road Traffic Injury prevention', released by WHO earlier this year. The sight of crumpled cars and overturned buses on major highways seems to have become part of the driving experience in the developing world. But the wreckage represents more than just a personal tragedy for the individuals involved in each accident. "Studies show that motor vehicle crashes have a disproportionate impact on the poor and vulnerable in society," said the WHO report. "The costs of prolonged medical care, the loss of the family breadwinner, the cost of a funeral, and the loss of income due to disability can push families into poverty." Road crash vicitims are disproportionately young, male and poor. The majority are pedestrians, cyclists, or users of public transport, with limited access to post-crash emergency medical care. "They benefit least from policies designed for motorised travel, but bear a disproportionate share of the disadvantages of motorisation in terms of injury, pollution and the separation of communities," WHO noted. This week was the funeral of Irene Banda, a 21-year-old single mother, who was hit by a car on 5 June while trying to cross the busy Seke Road that connects the Zimbabwean capital, Harare, with the satellite town of Chitungwiza. According to the police, the motorist was speeding in a 70 km/h zone, a common occurrence on this road. Doctors struggled to determine the extent of her injuries, but the medical equipment needed to do the necessary tests was out of service at the two government hospitals in the capital - Parirenyatwa and Harare general. Irene never regained consciousness. Her employers managed to find the more than US $565 demanded by a private hospital, but on the day she had been booked in for a set of scans, she died, leaving behind a two-year-old child. Pedestrian deaths account for half of Swaziland's road fatalities, according to 2004 data released by the National Road Safety Board. In rural and peri-urban areas, where no pavements exist, pedestrians walk on the narrow single-lane roads, increasing the risk of being run over. If a pedestrian is hit by a car travelling at 50 km/h they stand an 80 percent chance of being killed, compared with a 10 percent risk at a speed of 30 km/h, according to WHO. The most dangerous road in Swaziland is the busy national highway connecting the capital, Mbabane, with the central commercial town of Manzini and the Matsapha Industrial Site. Opened in 1998, it has come to be known as the "death road". The risk factor is increased by the number of livestock grazing beside it - a perennial hazard across much of southern Africa. Malawi has an annual road traffic fatality rate of 240 deaths per 10,000 vehicles, one of the highest in Africa, according to a recent study by the country's Road Traffic Commission (RTC). "There are three main causes of accidents in Malawi: the driver's behaviour, the condition of the vehicle, and [road] infrastructure," police officer Henry Banda told IRIN last week, while out on patrol checking on the roadworthiness of cars in the capital, Lilongwe. TAKING ACTION In Zambia the government is currently focusing on the behaviour of drivers and the police have finally banned motorists from eating, drinking or using cell phones while driving. "As police we have noticed this lack of attention by drivers and have linked it to the increasing number of road accidents," said police spokesperson Brenda Mutemba. Motorists will be charged about $50 if they are caught violating the road safety rules and will have 20 points deducted from their driver's license. If they rack up more than 50 points, they lose their license. Last year there were 21,692 road traffic accidents in Zambia, in which 1,046 people were killed and 2,696 seriously injured; an increase on the 2002 figure of 8,855 accidents and 1,000 fatalities. Zambians generally blame the drivers of public transport vehicles for their lack of road sense. But they also hold the local authorities accountable for not maintaining the dilapidated road infrastructure, which was originally built in the 1970s. Most roads in Zambia have huge pot holes that often cause accidents when motorists try to avoid them, while many of the street lights do not work, making it difficult to see pedestrians in the dark. Joseph Nkoloa, who last year formed the NGO, The Children's Road Safety Trust Fund, said there was a lack of road safety awareness among pedestrians. Children and the elderly were particularly vulnerable because they did not understand road signs, and the fund was trying to introduce road safety awareness into the school curriculum. "Most of our drivers have not gone to driving school," commented Dr Francis Kasolo at the University Teaching Hospital in the capital, Lusaka. The police lacked breathalyser test kits, and corruption, which allowed unroadworthy vehicles to pass through road blocks after a bribe had been paid, were contributing to the carnage on the roads. Speeding and alcohol were two significant factors in increasing the likelihood of traffic accidents. One study in South Africa found that alcohol was a factor in over 47 percent of fatally injured drivers and 61 percent of fatally injured pedestrians. Driver fatigue, poor visibility of other road users, inattention to safety in road construction, the non-use of seatbelts or motorbike helmets, and poor medical care at the crash site and in hospital, also contributed to fatality levels. SAFETY IN MIND Rather than simply chalking accidents down to human error, "the design and layout of the road, the nature of the vehicle, and traffic laws and their enforcement - or lack of enforcement - affect behaviour in important ways," WHO pointed out. The traditional response has been to get people to adopt "error-free" behaviour through public information campaigns. The more effective approach is to focus on the better design of the entire "transport system", which should be aimed at minimising risk and protecting vulnerable road users. Swaziland has been on a highway-building boom for a decade, extending the road system by 25 percent, but it found the number of traffic accidents was increasing. Motorists drove too fast on roads which had not been built with safety in mind. In response, new better-planned highways are being built with, for example, improved guard rails to lessen car impact and save motorists' lives, and which offer greater protection to pedestrians. A decade ago, it was virtually unknown for a drunk driver to be stopped or arrested. Now, highway checkpoints are common. "Police are succeeding in arresting drunk drivers. They can be jailed overnight, and face fines," Assistant Superintendent Vusie Masuku, spokesman for the Royal Swaziland Police Force, told IRIN. "Road traffic deaths and serious injuries are to a great extent preventable, since the risk of incurring injury in a crash is largely predictable and many countermeasures, proven to be effective, exist. Road traffic injury needs to be considered alongside heart disease, cancer and stroke as preventable public health problems that respond well to targeted interventions," said the WHO report. It pointed out that there were many examples of low-cost technology transfers suitable for the developing world, from speed humps in urban areas, rumble strips to slow down traffic at dangerous intersections, to clearing roadsides of hazardous objects and providing cyclists and pedestrians with safe paths to keep them off the roads. But, "While there are many interventions that can save lives and limbs, political will and commitment are essential, and without them little can be achieved. The time to act is now. Road users everywhere deserve better and safer roads," WHO concluded.