Katharine A. Allen

Addressing the Implementation Gap in Global Road Safety: Exploring Features of an Effective Response and Introducing a 10-Country Program

Yearly, more than 1.2 million people are killed by road traffic injuries (RTIs) around the globe, and another 20 to 50 million are injured. The global burden of RTIs is predicted to rise. We explored the need for concerted action for global road safety and propose characteristics of an effective response to the gap in addressing RTIs. We propose that a successful response includes domains such as strong political will, capacity building, use of evidence-based interventions, rigorous evaluation, increased global funding, multisectoral action, and sustainability. We also present a case study of the global Road Safety in 10 Countries project, which is a new, 5-year, multipartner initiative to address the burden of RTIs in 10 low- and middle-income countries.

Large-scale road safety programmes in low- and middle-income countries: An opportunity to generate evidence

The growing burden of road traffic injuries, which kill over 1.2 million people yearly, falls mostly on low- and middle-income countries (LMICs). Despite this, evidence generation on the effectiveness of road safety interventions in LMIC settings remains scarce. This paper explores a scientific approach for evaluating road safety programmes in LMICs and introduces such a road safety multi-country initiative, the Road Safety in 10 Countries Project (RS-10). By building on existing evaluation frameworks, we develop a scientific approach for evaluating large-scale road safety programmes in LMIC settings. This also draws on ‘13 lessons’ of large-scale programme evaluation: defining the evaluation scope; selecting study sites; maintaining objectivity; developing an impact model; utilising multiple data sources; using multiple analytic techniques; maximising external validity; ensuring an appropriate time frame; the importance of flexibility and a stepwise approach; continuous monitoring; providing feedback to implementers, policy-makers; promoting the uptake of evaluation results; and understanding evaluation costs. The use of relatively new approaches for evaluation of real-world programmes allows for the production of relevant knowledge. The RS-10 project affords an important opportunity to scientifically test these approaches for a real-world, large-scale road safety evaluation and generate new knowledge for the field of road safety.

Epidemiology of occupational injuries by nationality in Qatar: Evidence for focused occupational safety programmes

INTRODUCTION Occupational injuries are the second leading cause of trauma admission in Qatar. Given the wide diversity of the countrys migrant worker populations at risk, this study aimed to analyse and describe the epidemiology of these injuries based on the workers nationality residing in Qatar. METHODS A retrospective analysis of trauma registry data on occupational-related injuries was conducted. The analysis included all patients [aged ≥18 years] admitted to the Level I Hamad Trauma Center, from January 1, 2010 to December 31, 2013. RESULTS Out of 6555 trauma admissions, 2015 (30.7%) patients had occupational injury. The admitted Case Fatality Rate (CFR) was 4.3 per 100 occupational injury related trauma admissions. Overall non-fatal occupational injury rate was 37.34 per 100,000 workers, whereas fatal injury rate was 1.58 per 100,000 workers. Most of the workers experiencing occupational injuries were from Nepal (28%), India (20%) and Bangladesh (9%). Fatal occupational injuries were predominately among Indians (20%), Nepalese (19%), and Filipinos/Bangladeshis (both 8%). Filipinos had the highest admitted CFR at 8.2 deaths per 100 trauma admissions with the next highest being Indians and Indonesians (4.2 per 100 trauma admissions). During the study period, the incidence of severe occupational injuries decreased despite a simultaneous increase in the worker population within Qatar. Almost one in four occupational injuries was a major trauma (ISS≥16). Nepalese and Indian workers represented 29% and 18% of all major trauma cases. CONCLUSIONS Non-fatal occupational injuries appear to follow a pattern distinct from fatal ones. High-risk worker populations as defined by those with high admitted CFRs, experiencing the most severe or fatal injuries, must be the focus of targeted risk factor analysis and occupational safety interventions.

Injuries and violence in the Eastern Mediterranean Region: a review of the health, economic and social burden.

We review current literature and data on the burden of injury and violence in the Eastern Mediterranean Region (EMR) of the World Health Organization (WHO), with a special focus on the health, economic and social burden they impose on individuals, families and society. Injury-associated mortality and disability is on the rise in EMR, especially among economically productive adults, young males and vulnerable road users. In particular, road traffic injuries, the leading cause of injuries, account for 27% of the total injury and violence mortality in EMR according to WHO. Violence including suicide, homicide and war-related injury has also been increasing over the past two decades for both females and males. There is need for greater interest and efforts in slowing and ultimately halting the trend through interventions, legislative actions, and research that examine the special needs and challenges in the Region.

Trauma care in Oman: A call for action

Many Arab countries have undergone the epidemiologic transition of diseases with increasing economic development and a proportionately decreasing prevalence of communicable diseases. With this transition, injuries have emerged as a major cause of mortality and morbidity in the Gulf Cooperation Council countries in addition to diseases of affluence. Injuries are the number one cause of years of life lost and disability-adjusted life-years in the Sultanate of Oman. The burden of injuries, which affects mostly young Omani males, has a unique geographic distribution that is in contrast to the trauma care capabilities of the country. The concentration of health care resources in the northern part of the country makes it difficult for the majority of Omanis who live elsewhere to access high-quality and time-sensitive care. A broader multisectorial national injury prevention strategy should be evidence based and must strengthen human resources, service delivery, and information systems to improve care of the injured and loss of life. This paper provides a unique overview of the Omani health system with the goal of examining its trauma care capabilities and injury control policies.

The relationship between four-wheel drives and risky driving behaviours

BACKGROUND: Given the increased number of four wheel drive (4WD) vehicles in Qatar and their involvement in crashes, casualties and road fatalities, it is important to understand the association between risky driving behavior and 4WD crashes. Aim/Objective: This study aimed to determine the association between risky driving behaviours and 4WD vehicles and its impact on road traffic accidents in the State of Qatar. MATERIALS AND METHODS: A cross sectional survey was conducted using a multistage stratified cluster sampling technique to recruit 1824 drivers of two wheel drive (small cars) and 4WD across different primary health centres (PHCs) in Qatar. The Driver Behaviour Questionnaire (DBQ) and Driver Skill Inventory (DSI) were used to collect the data. Information regarding socio-demographic and road traffic crashes during last three years was also obtained. Multivariate logistic regression was used to analyse the data. RESULTS: 762 (41.8%) owned 4WD vehicles. Drivers of 4WD were significantly higher between 30-50 years age (P CONCLUSION: The drivers of 4WD cars are at higher risk of crashes as compared to the drivers of small cars. Also, they have significantly more traffic violations, lapses, and errors. Future interventions and control measures should target the drivers of 4WD for better results. Language: en

Development of an mHealth trauma registry in the Middle East using an implementation science framework.

ABSTRACT Background: Trauma registries (TRs) play a vital role in the assessment of trauma care, but are often underutilized in countries with a high burden of injuries. Objectives: We investigated whether information and communications technology (ICT) such as mobile health (mHealth) could enable the design of a tablet-based application for healthcare professionals. This would be used to inform trauma care and acquire surveillance data for injury control and prevention in Oman. This paper focuses on documenting the implementation process in a healthcare setting. Methods: The study was conducted using an ICT implementation framework consisting of multistep assessment, development and pilot testing of an electronic tablet-based TR. The pilot study was conducted at two large hospitals in Oman, followed by detailed evaluation of the process, system and impact of implementation. Results: The registry was designed to provide comprehensive information on each trauma case from the location of injury until hospital discharge, with variables organized to cover 11 domains of demographic and clinical information. The pilot study demonstrated that the registry was user friendly and reliable, and the implementation framework was useful in planning for the Omani hospital setting. Data collection by trained and dedicated nurses proved to be more feasible, efficient and reliable than real-time data entry by care providers. Conclusions: The initial results show the promising potential of a user-friendly, comprehensive electronic TR through the use of mHealth tools. The pilot test in two hospitals indicates that the registry can be used to create a multicenter trauma database.

PW 1092 Prevalence of behavioral risk factors for road traffic injuries in three south american cities

Road traffic injuries (RTIs) are an important cause of death and injury in Colombia and Brazil. This burden is not uniform across countries and cities. Understanding these differences and similarities in road traffic behaviors is key in designing effective RTI interventions. This study is aimed to assess such differences by comparing observed road safety behaviors in three South American cities, Bogotá (Colombia), and São Paulo and Fortaleza (Brazil). As part of the Bloomberg Initiative for Global Road Safety (BIGRS), observational studies were conducted in Bogotá, Fortaleza, and São Paulo. Trained observers recorded road safety behavior (speeding, helmet use, seatbelt use and drink driving) every six months between August 2015 and September 2017. Around 1.5 million observations in these risk factors have been collected throughout six rounds of data collection. It was found that Bogotá and São Paulo had varying rates of speeding, very dependent on changes in policy and enforcement circumstances, whereas Fortaleza maintained relatively high and stables rates. Rates of seatbelt and correct helmet use among all passengers were higher in São Paulo than Bogotá and Fortaleza. Drink driving prevalence was higher in Sao Paulo than Fortaleza and Bogotá. Fortaleza has experienced a reducing trend in drink driving prevalence throughout the project. In São Paulo, refusal rates reached 76%. Important regional differences in road safety risk factors highlight the need for tailored interventions in South American cities. Speeding is a priority for Bogotá and Fortaleza. São Paulo’s alcohol results illustrate the urgency for drink driving-based interventions and correct helmet use is an increasingly important need in Bogotá and Fortaleza. These results are being used to develop specific interventions for BIGRS. These results are of interest for policy makers in Latin American cities and other middle-income countries where these interventions can be piloted and if effective, scaled up and replicated.

PW 0982 Prevalence of behavioral risk factors for road traffic injuries in the city of sao paulo: findings from the bloomberg initiative for global road safety (BIGRS) 2015–2017

Background Sao Paulo is one of the world’s largest urban areas and it was selected as one of the ten cities for the Bloomberg Initiative for Global Road Safety (BIGRS) project. With nearly 12 million inhabitants and 8 million vehicles, the city has reached a significant decline in road traffic mortality during the last decade (7 deaths per 1 00 000 inhabitants in 2016). Objective To evaluate the performance of interventions aiming to reduce the prevalence of four key road safety risk factors (speeding, drink and driving, seatbelt and helmet use) during 2015–2017 in the city of Sao Paulo, Brazil. Methods Following a baseline study performed in 2015, observational studies monitoring these risk factors were performed twice a year. Six to eight different locations were randomly selected to represent the main regions of the city, where drivers’ behaviors were observed during all days of the week using an internationally validated protocol. Findings The prevalence of speeding at baseline (10%) decreased substantially to 5% in 2016 following citywide speed limit reduction interventions, but increased again (9%) by the end of 2017 after interventions were reverted. Drivers testing above the legal blood alcohol concentration (BAC) limit (0.01%) presented a decreasing trend (from 4.1% to 1.2%); however, more than half of drivers currently refuse breathalyzer tests. Driver’s seatbelt use rate has kept constant at approximately 90%, as well as rear’s passengers usage rate, but at a much smaller proportion (22%). Helmet use among drivers and passengers presented a highly consistent percentage, with nearly all motorcycle drivers wearing helmets correctly. Conclusion and policy implications Speeding and drink driving are the most prevalent risk factors observed among drivers, but interventions addressing these behaviors have demonstrated a positive association with their reduction. Future strategies addressing rear seatbelt use and correct helmet wearing should also be promoted.

Descriptive epidemiology of injury cases: findings from a pilot injury surveillance system in Abu Dhabi

Considering the high burden of injuries, the Health Authority - Abu Dhabi developed a draft electronic and paper-based injury and poisoning notification system (IPNS) to generate better data on the nature and severity of injuries. The pilot testing and evaluation of IPNS was conducted with the specific objectives to (1) identify the characteristics of injury cases, (2) explore potential risk factors, (3) illustrate the nature and type of data, and (4) the working mechanism of data collection. Data were collected from selected hospitals on patient demographics, injury information and clinical assessment. Descriptive, bivariate and multivariate analyses were conducted. Of 4226 injury cases, nearly three-fourths were male, majority were non-UAE nationals, and the mean age was 21.9. Multivariate findings suggested that compared to UAE nationals, non-UAE nationals were 27% more likely to experience fatal, severe or moderate injuries (p = 0.01). Individuals with health insurance were 31% less likely to suffer a fatal, severe or moderate injury compared to those having no health insurance (p < 0.001). This is the first systematically standardised collection of injury data across three facilities in Abu Dhabi, and provides initial information on characteristics and injury risk factors that will help identify the need for evidence-based intervention for injury prevention and control.