Jonathon Passmore

Impact of Mandatory Motorcycle Helmet Wearing Legislation on Head Injuries in Viet Nam: Results of a Preliminary Analysis

Objective: To compare estimated prevalence of head injuries among road traffic injury patients admitted to hospitals, before and after the introduction of a mandatory helmet law in the Socialist Republic of Viet Nam. Methods: Before and after study of all road traffic injury patients with head injuries admitted to 20 provincial and central hospitals 3 months before and after the new law came into effect on 15 December 2007. Relative risk was computed and comparison made for the periods of 3 months before and after the new law. Results: The study found a 16 percent reduction in the risk of road traffic head injuries (4683 to 3522; relative risk [RR] 0.84; 95% confidence interval [CI] 0.81–0.87) and an 18 percent reduction in the risk of road traffic death (deaths in hospital plus injured patients discharged to die at home; 566 to 417; RR 0.82; 95% CI 0.73–0.93). Conclusions: Over the first 3 months of the comprehensive mandatory helmet legislation there has been a significant reduction in the risk of road traffic head injuries among patients admitted to 20 hospitals. The Viet Nam Governments decision to require all motorcycle riders and passengers to wear helmets is suspected of leading to positive road safety benefits and should be seen as a policy example for other low- and middle-income countries with a high utilization of motorcycles for transport.

Viet Nam's mandatory motorcycle helmet law and its impact on children

OBJECTIVE To measure the use of motorcycle helmets in children and to determine the reasons why children wear helmets less often than adults. METHODS The frequency of helmet wearing among adults and children was ascertained by trained roadside observers, and randomized road user surveys were completed in four major centres in Viet Nam: Hanoi, Ho Chi Minh City, Can Tho and Da Nang. Survey data on key questions were cross tabulated, and chi2 was calculated for significant differences between parents and non-parents (0.05). FINDINGS The frequency of helmet use in the four study locations ranged from 90-99% among adults, from 15-53% among children <or=7 years of age, and from 38-53% among children > 7 but <or= 14. Of the parents surveyed, 67% said the fear of neck injury was the most important reason their children did not wear a helmet. CONCLUSION Children wear motorcycle helmets much less often than adults. Legislation to penalize adults whose children do not wear motorcycle helmets has been proposed in Viet Nam. Furthermore, ongoing advocacy and social marketing efforts are being made to disseminate information about the safety benefits of helmets to combat erroneous public perceptions.

The formulation and implementation of a national helmet law: a case study from Viet Nam

PROBLEM Road traffic injuries are a leading cause of death and disability in Viet Nam. In 2008, official data reported 11 243 deaths and 7771 serious injuries on the roads, of which an estimated 60% of fatalities occur in motorcycle riders and passengers. In recognition of this problem, Viet Nam has had partial motorcycle helmet legislation since 1995. However, for a variety of reasons, implementation and enforcement have been limited. APPROACH On 15 December 2007, Viet Nams first comprehensive mandatory helmet law came into effect, covering all riders and passengers on all roads nationwide. Penalties increased ten-fold and cohorts of police were mobilized for enforcement. LOCAL SETTING The Viet Nam national helmet legislation was developed and implemented by the National Traffic Safety Committee. RELEVANT CHANGES Despite past barriers to enforcement, increased policing in 2008 led to 680 000 infringements being issued for non-helmet wearing. While changes in helmet wearing were not nationally observed, significant increases were documented in selected provinces in the first six months of the laws introduction. In Da Nang, helmet wearing increased from 27 to 99%. In the first three months after the law took effect, surveillance data from 20 urban and rural hospitals, found the risk of road traffic head injuries and deaths decreased by 16% and 18% respectively. LESSONS LEARNT Political leadership, intensive advanced public education and stringent enforcement have contributed to the successful implementation of the new law. Through continual monitoring of the legislation, loopholes detrimental to the effectiveness of the law have been identified and addressed.

Drinking and Driving in Vietnam: Public Knowledge, Attitudes, and Practices

Objective: Injuries are among the 10 leading causes of death for all ages in Vietnam, and road traffic fatalities account for approximately half of those deaths. Despite having what is considered to be one of the most stringent alcohol legislations in the region, alcohol involvement in road traffic crashes remains high. This study aims to illustrate the knowledge, attitudes, and practices around alcohol use and drinking and driving by age and sex in 3 provinces in Vietnam. Methods: This study was conducted between January and February 2011, surveying randomly selected road users over the age of 17 years at gas stations in 3 provinces: Ha Nam, Ninh Binh, and Bac Giang, Vietnam. Data were collected for one week at each gas station. A knowledge, attitudes, and practices (KAPs) survey was administered in 7 time blocks of 90 min throughout the day, from 07:30 am to 9:30 pm. Results: There were a total of 633 respondents almost evenly divided among the 3 provinces. Males accounted for 69.1 percent of respondents; the majority were 36 years of age or younger. Despite the belief that drinking and driving will increase the risk of a crash, a significant proportion of respondents (44.9%) reported drinking and driving; 56.7 percent admitted to drinking and driving within the last month. Drinking and driving was more common among males, with approximately 60.2 percent indicating a history of drinking and driving. This proportion was particularly high among males aged 17 to 26 (71.4%). It was found that preferred alternatives to drinking and driving when available were leaving with a nondrinker (42%), resting until “feeling conscious” (23%), and drinking less (20%). Conclusions: This study shows that, in general, alcohol use and drinking and driving remain a problem in Vietnam, a major concern given that the country is rapidly motorizing and likewise increasing the likelihood of road traffic crashes in the absence of effective interventions. To target drinking and driving in Vietnam we call for a multifaceted approach, including social marketing and public education campaigns, enhanced enforcement, and programs that either limit the number of drinks to drivers or young individuals or those that provide alternatives to drinking and driving.

True burden of drowning: compiling data to meet the new definition

The objective and aim of the study was to compile empirical data to quantify the underestimation of the true burden of drowning and to compare drowning rates using commonly reported codes compared with those revealed by use of the full range of drowning codes in ICD version 10. The authors reviewed mortality data (1999 – 2002) from Australia and the USA and compiled data to compare the burden of ‘unintentional drowning’ with that of ‘all drowning’. In both Australia and the USA, drowning mortality is more than 35% higher when a full range of codes is examined. A more comprehensive representation of the drowning problem is needed to assist in strengthening prevention activities.

Measuring compliance with Viet Nam's mandatory motorcycle helmet legislation

The objective of this roadside observational study was to monitor helmet wearing among motorcycle riders and passengers in three provinces (Yen Bai, Da Nang and Binh Duong) in the Socialist Republic of Viet Nam, before and after a mandatory helmet law took effect on 15 December 2007. A total of 665,428 motorcycle riders and passengers were observed between November 2007 and February 2011 at 45 randomly selected sites covering the entire road network. Across all locations and time periods, correct helmet wearing averaged 40.1% before the law and 92.5% after; however, there were significant differences between time points and locations. The Viet Nam Governments decision to require all motorcycle riders and passengers to wear helmets has been thoroughly implemented nation wide and the results show that high wearing has been sustained. Further study is required on how high helmet wearing has and will translate into a reduction in motorcycle head injuries; however, Viet Nams motorcycle helmet legislation should be seen as an important policy example for other low- and middle-income countries with a high utilization of motorcycles for personal transport.

Role of Alcohol in Hospitalized Road Trauma in Viet Nam

Objective: To assess the blood alcohol concentration (BAC; dependent variable) of patients with road traffic injuries (RTIs) presenting at 3 provincial and central hospitals in the Socialist Republic of Viet Nam by age, sex, and road user type (independent variables). This survey formed part of the Viet Nam Road Traffic Injury Prevention Project, funded by Bloomberg Philanthropies. Introduction: RTIs are a leading cause of death and disability in Viet Nam, with 14,690 deaths and 143,940 injuries reported by the Ministry of Health (MOH) in 2010. Research estimates suggest that motorcycle riders and passengers account for 60 percent of fatalities. Alcohol has long been suspected of being a leading cause of road traffic collisions and injuries. However, until now data on this relationship have been limited. Methods: A descriptive cross-sectional study measuring BAC in all consenting patients with RTIs presenting at 3 provincial or central hospitals between July 2009 and September 2010. All results were anonymous and summary information on key variables was sent to MOH and the World Health Organization (WHO) on a monthly basis. Results: Of the 36,418 patients with RTIs presenting to these 3 hospitals between July 2009 and September 2010, BAC analysis was completed on 14,990 patients (41.2%), representing all patients with RTIs 15 years of age and above who consented to anonymous testing. BAC results ranged from 0 to 0.589 g/dL blood, with a mean of 0.0441 g/dL being the average concentration among all tested patients. Of all patients tested, 56.8 percent had no detectable alcohol in their system. Motorcycle riders were most commonly represented in the tested sample (70.7%), with 27.8 percent having a BAC above the legal limit (0.05 g/dL). Car or other vehicle drivers represented 2.7 percent of the sample, with 63.4 percent tested having a BAC above 0 g/dL, the legal limit for these road users. Conclusions: The results of this preliminary study indicate that 29.1 percent of all car drivers and motorcycle riders presenting at hospitals with RTIs exceeded the legal BAC limit for operating a motor vehicle. Though further study is required, this is suggestive that strengthening the enforcement of drink-driving laws is an urgent national road safety priority.

Drinking & driving in Viet Nam: Prevalence, knowledge, attitudes, and practices in two provinces

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.

Drink driving prevention in Ha Nam and Ninh Binh provinces of Viet Nam

Background Drink driving is a major risk factor for road trauma in Viet Nam. Previous studies have shown up to 60% of road traffic injured patients admitted to hospital, had a blood alcohol concentration (BAC) above the level limit. Activities This programme implemented an enhanced enforcement model where roadside police operations were supplemented by capacity building training for police, essential equipment (breathalysers), and an intensive mass media social marketing campaign on the dangers and consequences of drink–driving. Impact of the programme was measured through a variety of evaluation tools including enforcement data, hospital BAC results and KAP indicators. Results The social marketing campaign was implemented from August 2010 to November 2011, coupled with almost 7000 person days of enforcement operations running from November 2010 to November 2011 during high alcohol times (12:00–14:00 and 18:00–21:00). Enforcement results from HaNam and NinhBinh showed 23.3% and 21.3% drivers/riders respectively were detected over the legal limit. Theres a reduction in peoples self reported drink driving between January and August 2011, HaNam from 34.1% to 20% and NinhBinh from 52.2% to 44.2%. However, the low perception of being caught drink driving (24.3%) could possibly add to the current high violation rate. The volume of intake among hospitalised victims reduced. Motorcycle victims having BAC level over 80 mg/dl declined from 21.5% to 11.5% in the 3rd quarter of 2011 in HaNam. Conclusions Drink driving remains highly prevalent in Viet Nam. However, intensive social marketing coupled with sustained visible enforcement can bring positive changes to peoples knowledge and likelihood of drinking and driving.

MOTORCYCLE HELMET WEARING IN VIET NAM: LEGISLATION, COMPLIANCE AND CURRENT CHALLENGES

Background With motorcycles representing 95% of Viet Nams 33 million vehicles, safety for this vulnerable user group is of crucial importance. Motorcycle helmets are an effective road safety intervention that has been implemented to various degrees in Viet Nam since 1995. Previous attempts were largely unsuccessful until the mandatory law took effect from 15 December 2007. Purpose To review the history of motorcycle helmet legislation in Viet Nam including factors that have contributed to or impeded successful implementation and current challenges and potential solutions. Methods Various sources of information were utilised including primary and secondary data on helmet wearing and road trauma, Vietnamese road safety legislative documents and personal communication with key local road safety stakeholders. Results More than 15 000 road traffic fatalities were reported in 2010 of which an estimated 75% are motorcycle riders and passengers. With the implementation of the national law in 2007, wearing increased from approximately 42% to more than 99% in select locations and importantly has been maintained. Whilst information is limited, small but significant reductions in the number of head injuries have been reported since the introduction of the law. Enforceability of helmet wearing for child passengers as well as the quality of helmets remain major ongoing challenges. Significance Road trauma is a leading cause of death in Viet Nam, however the successful introduction of mandatory helmet legislation is a major milestone for improving road safety and represents important experience for other low and middle income countries where a large proportion travel by motorcycle.