Ahsan Kayani

Fatalism and its implications for risky road use and receptiveness to safety messages: a qualitative investigation in Pakistan

Given the increasing vehicle numbers and expanding road construction in developing countries, the importance of safe road user behaviour is critical. Road traffic crashes (RTCs) are a significant problem in Pakistan; however, the factors that contribute to RTCs in Pakistan are not well researched. Fatalistic beliefs are a potential barrier to the enhancement of road safety, especially participation in health-promoting and injury prevention behaviours, and also contribute to risk taking. Fatalistic beliefs relating to road safety have been found in some developing countries, although research is scarce and indicates that the nature and extent of fatalism differs in each country. Qualitative research was undertaken with a range of drivers, religious orators, police and policy makers to explore associations between fatalism, risky road use and associated issues. Findings indicate that fatalistic beliefs are pervasive in Pakistan, are strongly linked with religion, present a likely barrier to road safety messages and contribute to risky road use. Fatalism appears to be a default attribution of RTC and the intensity of belief in fate surpasses the kinds of fatalism noted in the limited existing literature. These findings have importance to developing road safety countermeasures in countries where fatalistic beliefs are strong.

Underreporting of road crashes in Pakistan and the role of fate

Objective: Comprehensive, accurate information about road crashes and related trauma is a prerequisite for identification and control of risk factors as well as for identifying faults within the broader road safety system. Quality data and appropriate crash investigation are critical in reducing the road toll that is rapidly growing in much of the developing world, including Pakistan. This qualitative research explored the involvement of social and cultural factors (in particular, fatalism) in risky road use in Pakistan. The findings highlight a significant issue, previously unreported in the road safety literature, namely, the link between fatalistic beliefs and inaccurate reporting of road crashes. Method: Thirty interviews (one-on-one) were conducted by the first author with police officers, drivers, policy makers, and religious orators in 3 Pakistani cities. Findings: Evidence emerged of a strong link between fatalism and the underreporting of road crashes. In many cases, crashes and related road trauma appear to go unreported because a crash is considered to be ones fate and, therefore, beyond personal control. Fate was also implicated in the practice of reconciliation between parties after a crash without police involvement and the seeking and granting of pardon for a road death. Conclusions: These issues represent additional factors that can contribute to underreporting of crashes and associated trauma. Together, they highlight complications involved in establishing the true cost of road trauma in a country such as Pakistan and the difficulties faced when attempting to promote scientifically based road safety information to counteract faith-based beliefs.

605 Non emergency calls at an emergency setting: mass awareness needed

Background Timely provision of emergency care reduces losses associated with trauma, fire or disaster. Rescue 1122 is an integrated emergency service offering emergency services and safer community programs in 37 major cities of Province Punjab, Pakistan. It operates through a toll free number, 1122. This study analyses the burden of Non-Emergency Calls (NECs) received on 1122. Methods Retrospective analysis of all received calls on 1122 during 2004-September 2015 was conducted. Data were collected from 37 major cities of Punjab. Results Rescue 1122 received over 79 million calls during study period; with only over three million (4%) emergency calls and 76 million (96%) NECs. There were 66 million (87%) Prank, 8 million (10.5%) Information Seeking and 1.8 million (2.5%) Wrong calls. Additionally, about 0.17 million (0.2%) Fake calls were also received, on which 3,964 false dispatches were made. Maximum NECs (around 14 million) were attended by Lahore Rescue 1122; while similar patterns of NECs were also experienced across Punjab. Rescue 1122 adopted various NECs counter-strategies that include: usage of questionnaire-based minimalist communication between anonymous caller and 1122 staff; software-based blacklisting and auto-blocking for habitual callers and calling back for deterrence. Conclusions Data analysis shows that NECs pose a massive burden on Rescue 1122. Excessive misuse of an emergency number suggests public’s lack of awareness and apathetic attitude that could result in death or serious outcome of an emergency. False dispatches made could have resulted in deprivation of emergency care to real emergencies and economic losses as well. Though, Rescue 1122 has adopted some counter-strategies, however that cannot lessen the burden of NECs. Therefore, a mass awareness campaign is needed to sensitise the public regarding the sensitivity of the issue.

855 Pedestrians at highest risk in Pakistan

Background Road crashes and injuries constitute a significant public health issue in Pakistan. Growing urbanisation and motorization trends, traffic violations, encroachments and lack of road safety awareness have placed pedestrians at highest risk in Pakistan. A recent study found that pedestrians constituted 53% of the reported fatalities in Islamabad, Pakistan during 2008 to 2010. Similarly, Road Traffic Injury Research and Prevention Centre recorded 1,130 road fatalities in Karachi during 2013, wherein 379 (33.5%) were pedestrians. The current research would be the first large scale study in the country that presents existing pedestrians safety scenario in Pakistan. Methods Retrospective analysis of Rescue 1122 (an emergency service in Pakistan) crash data for last two years period (July 2013- June 2015) was conducted. Data were collected from 37 major cities of Province Punjab. Results Rescue 1122 attended 407,628 road crashes across Punjab during the study period, wherein 76,737 pedestrians were injured. Of the total 5,317 fatalities, about 30% (n = 1,577) were pedestrians, and 80% of them were males. Maximum pedestrian injuries 19,916 (26%) were reported in Lahore, followed by 12,285 (16%) in Faisalabad and 4,876 (6%) in Gujranwala. Motorcycles (59%), trucks (10%) and cars (9%) were the major colliding vehicles with pedestrians. Whilst, speeding (42%), careless driving (32%) and wrong turn (12%) were the major crash contributing factors. Conclusions Pedestrians are at highest risk in Pakistan. Speeding, careless driving, disregard of right of way, encroachments and lack of road safety awareness amongst all road users are the major factors behind increasing road crashes and pedestrians’ vulnerability in Pakistan. Road crashes are not being dealt as a significant issue in Pakistan. Sustainable efforts on the part of government, transport organisations, law enforcers, community and media are required. School road safety education is also vital in this view.

667 Motorcycle one-wheeling: a fatal venture in Pakistan

Background Motorcycle one-wheeling (MOW) is one of the burgeoning factors in motorcycle crashes in Pakistan. Young One-wheelers (YOW) perform dangerous stunts such as riding motorcycle while laying flat, lifting front-wheel and their backs facing motorcycle handles. Consequently, they put themselves and others at risk. A newspaper reported that over 200 YOW died and around 1,300 other road users were injured or killed in MOW crashes during 2011–2013. Current research is the first in Pakistan that presents the most recent epidemiology of MOW crashes. Methods Retrospective analysis was conducted on crash data for last two years collected by Rescue 1122 (an emergency service in Pakistan) from 37 major cities of Province Punjab. Results Rescue 1122 attended 389 MOW crashes during the study period. Of them, maximum MOW crashes were reported in Kasur (n = 88), followed by Lahore (n = 69) and Rawalpindi (n = 41). In all 351 injuries and 16 fatalities were reported among YOW. Of the 351 injuries, about 70% were critical (head, spinal & fractures). All 16 fatalities were aged between 16 and 25 years. Most (19%) were aged 21 years, followed by 13% amongst aged 18, 19 and 22 years respectively. None of fatalities/injured YOW were wearing helmet. Most MOW crashes were reported on Pakistan Independence Day (14 August) and Chand Rat—a night before Eid, whilst some of them were also reported on normal week-days. Conclusions Prevalence of MOW crashes across Punjab is alarming, as initially this dangerous venture was only confined to large cities. In addition to major cities, MOW crashes are mostly reported from Kasur, which is a suburban city. Though MOW crashes constitute only 1% of reported crashes, their outcomes are very severe, as all MOW fatalities/injured included youngsters have devastating psycho-social impacts on the society. A serious effort is required on part of all the stakeholders. School road safety education with parents partaking is also very important in this view.

92 Religious and cultural factors: barriers to developing interventions and safety countermeasures

Background Most of the world’s people live in developing countries yet there has been limited application of scientific methods of injury control in many of them. Traditional cultural and religious values can act as a barrier to health-promoting and injury prevention behaviours, in general and especially in relation to road safety, and may also contribute to risk-taking behaviours. Such beliefs, including fatalism and superstition, can present significant challenges for health advocates who aim to change behaviour in order to avert road crashes and diminish their consequences. Methods Qualitative research was undertaken in Islamabad, Rawalpindi and Lahore in Pakistan with a range of drivers, religious orators, police and policy makers to explore cultural and religious beliefs and their association with risky road use, and to understand how they might affect development of road safety interventions. Results Overall, findings indicated a variety of strongly-held religious and cultural beliefs (such as fatalism and superstition), many that were non-scientific in nature, about road crash causation and ways in which people protect against harm on the road. The findings highlight a range of issues, including the identification of aspects of beliefs that have complex social implications when designing safety intervention strategies. The pervasive nature of such beliefs can affect road user behaviour by reinforcing the presumption that the individual has no part to play in safety, thereby supporting continued risk taking behaviours. Conclusions The mechanisms of culture and religion should be taken into account when trying to change attitudes and behaviours relating to public health. For effective road safety interventions in developing countries, it is important to understand the prevailing cultural and social beliefs towards road crashes which influence behaviour and thereby preventive measures and responses to interventions adapted from developed countries.