A.A. Hyder

Early impact of a national multi-faceted road safety intervention program in Mexico: Results of a time-series analysis

Background In January 2008, a national multifaceted road safety intervention program (IMESEVI) funded by the Bloomberg Philanthropies was launched in Mexico. Two years later in 2010, IMESEVI was refocused as part of a 10-country international consortium demonstration project (IMESEVI/RS10). We evaluate the initial effects of each phase of the road safety intervention project on numbers of RT crashes, injuries and deaths in Mexico and in the two main target cities of Guadalajara-Zapopan and León. Methods An interrupted time series analysis using autoregressive integrated moving average (ARIMA) modeling was performed using monthly data of rates of RT crashes and injuries (police data), as well as deaths (mortality system data) from 1999–2011 with dummy variables representing each intervention phase. Results In the period following the first intervention phase at the country level and in the city of León, the rate of RT crashes decreased significantly (p<0.05). Notably, following the second intervention phase although there was no reduction at the country level, there has been a decrease in the RT crash rate in both Guadalajara-Zapopan (p = 0.029) and in León (p = 0.029). There were no significant differences in the RT injury or death rates following either intervention phase in either city. Conclusion These initial results suggest that a multi-faceted road safety intervention program appears to be effective in reducing road crashes in a middle-income country setting. Further analysis is needed to differentiate the effects of various interventions, and to determine what other economic and political factors might have affected this change.

Potential gains in life expectancy by improving road safety in China

OBJECTIVES Road traffic injuries (RTI) cause a significant number of injuries and deaths in China every year; the World Health Organization estimated 261,367 deaths due to RTI in 2013. As a result of the ongoing growth of Chinas economy, road construction and motorisation, RTI are expected to impose a heavy health burden in the future. However, the public and policy makers have not widely perceived RTI as a public health issue commensurate with its consequences, in part, due to a lack of intuitive indicator measuring the health impact. STUDY DESIGN Employs the cause-eliminating life table technique to provide a measure of the burden of RTI based on data from a nationally representative surveillance system in China. METHODS Previous studies have used indicators such as event counts, rates and disability-adjusted life years to measure the health impact of RTI; but this study uses potential gains in life expectancy to measure this impact. RESULTS Eliminating RTI could lead to a gain of 0.52 years in life expectancy in 2012, meaning that on average Chinese people could live a half year more than they would in the presence of RTI. Males have a substantially higher RTI death rate and consequently could have a gain in life expectancy more than twice as large as females (male 0.72 years vs female 0.28 years). The gain in rural areas (0.65 years) is twice that in urban areas (0.32 years). CONCLUSIONS The significant gain in life expectancy signals the urgency for public actions to improve road safety; the disparity in the burden across regions and sexes indicate a great opportunity for targeted interventions to protect health and save lives.

One hundred injured patients a day: multicenter emergency room surveillance of trauma in Pakistan

OBJECTIVES Injuries increasingly contribute to the global burden of disease in low- and middle-income countries. This study presents results from a large-scale surveillance study on injury from several urban emergency departments (EDs) in Pakistan. The objective is to document the burden of injuries that present to the healthcare system in Pakistan and to test the feasibility of an ED-based injury and trauma surveillance system. STUDY DESIGN Cross-sectional study conducted using active surveillance approach. METHODS This study included EDs of seven tertiary care hospitals in Pakistan. The data were collected between November 2010 and March 2011. All patients presenting with injuries to the participating EDs were enrolled. The study was approved by the Institutional Review Boards of the Johns Hopkins School of Public Health, Aga Khan University, and all participating sites. RESULTS The study recorded 68,390 patients; 93.8% were from the public hospitals. There were seven male for every three female patients, and 50% were 20-39 years of age. About 69.3% were unintentional injuries. Among injuries with a known mechanism (19,102), 51.1% were road traffic injuries (RTIs) and 17.5% were falls. Female, patients aged 60 years or older, patients transferred by ambulance, patients who had RTIs, and patients with intentional injuries were more likely to be hospitalized. CONCLUSION The study is the first to use standardized methods for regular collection of multiple ED data in Pakistan. It explored the pattern of injuries and the feasibility to develop and implement facility-based systems for injury and acute illness in countries like Pakistan.

Hand injuries in low- and middle-income countries: systematic review of existing literature and call for greater attention

OBJECTIVES Hand injuries result in major healthcare costs from lack of productivity and disability. With rapid industrialization, the incidence of hand injuries is expected to rise in low- and middle-income countries (LMICs). However, estimates of burden and validated outcome tools are needed for effective resource allocation in the management of these injuries. STUDY DESIGN We conducted a systematic review to evaluate the burden of hand injuries in LMICs according to Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. METHODS We searched PubMed, Scopus, Embase, Cochrane Library, PAIS International, African Index Medicus, Global Health, IMMEMR, IMSEAR, Wholis and Bdenf, Lilacs, Scielo, WPRIM, and WHO International Clinical Trials Registry Platform to detect eligible articles with no restrictions on length of follow-up, type of hand injury, or date. RESULTS We included 17 articles after screening 933 eligible articles based on title, abstract, and full-text screening. There was significant heterogeneity and low quality of evidence. All included articles suggest that hand injuries were associated with work limitations for the majority of patients, and residual pain can further limit their activities. Direct and indirect costs related to treatment account for a major healthcare burden with limited evidence on estimates of long-term cost from disability. CONCLUSIONS The present systematic review highlights the paucity of high-quality data on the epidemiology, management, and burden of hand injuries in LMICs. The data are heterogeneous, and comprehensive metrics are lacking. Because hand injuries can account for a significant proportion of injury-related disability, reducing the overall burden of hand injuries is of utmost importance.

Evaluation of the five-year Bloomberg Philanthropies Global Road Safety Program in the Russian Federation

Road traffic injuries are a leading cause of morbidity and mortality in the world. In Russia, a road safety program was implemented in Lipetskaya and Ivanovskaya oblasts (regions) as part of a 10-country effort funded by Bloomberg Philanthropies. The program was focused on increasing seat belt and child restraint use and reducing speeding. The primary goals of this monitoring and evaluation study are to assess trends in seat belt use, child restraint use, and speed compliance in the two oblasts over the 5 years and to explore the overall impact of the program on road traffic injury and death rates. Primary data via roadside observations and interviews, and secondary data from official government sources were collected and analyzed for this study. Our results indicate significant improvements in seat belt wearing and child seat use rates and in prevalence of speeding in both intervention oblasts. The observations were consistent with the results from the roadside interviews. In Lipetskaya, restraint use by all occupants increased from 52.4% (baseline, October 2010) to 77.4% (final round, October 2014) and child restraint use increased from 20.9% to 54.1% during the same period. In Ivanovskaya, restraint use by all occupants increased from 48% (baseline, April 2012) to 88.7% (final round, October 2014) and child restraint use increased from 20.6% to 89.4% during the same period. In Lipetskaya, the overall prevalence of speeding (vehicles driving above speed limit) declined from 47.0% (baseline, July 2011) to 30.4% (final round, October 2014) and a similar pattern was observed in Ivanovskaya where the prevalence of speeding decreased from 54.6% (baseline, March 2012) to 46.6% (final round, October 2014). Through 2010-2014, the road traffic crash and injury rates per 100,000 population decreased in Lipetskaya oblast (191.5 and 246.9 in 2010 and 170.4 and 208.6 in 2014, respectively) and slightly increased in Ivanovskaya oblast (184.4 and 236.0 in 2010 and 186.7 and 243.4 in 2014, respectively). These road safety improvements are associated with the program that enabled a combined focus on policy reform, legislation, enforcement, advocacy, education, and data collection and use. However, the existence of other road safety efforts, lack of data from comparable regions, and unavailability of risk factor-specific data make it difficult to attribute these changes to the program.

INCREASING SEATBELT USE AND POTENTIAL LIVES SAVED IN ONE REGION OF RUSSIA

Background The use of seatbelts is an important means of reducing the risk of death or serious injury; yet the seatbelt use rate in Russia is not optimal. The Road Safety 10-Country (RS-10) Project, implemented social marketing campaigns and other interventions since November 2010 in Lipetskaya Oblast, Russia. Aims/Objectives/Purpose To evaluate the initial impact of these interventions in improving seatbelt use and preventing deaths in the future. Methods Five rounds of observational studies were conducted on the use of seatbelts in the Lipetskaya region during October 2010 and December 2011. Data were collected in six districts and three different road types, making a total of 18 sites in each round. We also predicted the number of deaths avoided through increased seatbelt use among drivers and front seat passengers. Results In the baseline, a total of 26 897 vehicles and 41 921 drivers and passengers were observed, among which 56% of drivers, 58% front seat passengers, and only 7% of back seat passengers were observed to use seatbelts. Since the implementation of the interventions, seatbelt use has continuously increased: among drivers, it increased from 56% to 75%; among front seat passengers, it increased from 58% to 78% in December 2011. Our estimated number of lives saved among drivers and front seat passengers through increased seatbelt use ranges between 18 and 23 deaths in 2011. Significance/Contribution to the Field This study at sub-national level in Russia shows initially promising effects of road safety interventions in improving seatbelt use and preventing future deaths.