Margie Peden

Pedestrian Safety and the Built Environment : A Review of the Risk Factors

Urban and regional planning has a contribution to make toward improving pedestrian safety, particularly in view of the fact that about 273,000 pedestrians were killed in road traffic crashes in 2010. The road is a built environments that should enhance safety and security for pedestrians, but this ideal is not always the case. This article presents an overview of the evidence on the risks that pedestrians face in the built environment. This article shows that design of the roadway and development of different land uses can either increase or reduce pedestrian road traffic injury. Planners need to design or modify the built environment to minimize risk for pedestrians.

The use of non-standard motorcycle helmets in low- and middle-income countries: a multicentre study

Background The use of non-standard motorcycle helmets has the potential to undermine multinational efforts aimed at reducing the burden of road traffic injuries associated with motorcycle crashes. However, little is known about the prevalence or factors associated with their use. Methods Collaborating institutions in nine low- and middle-income countries undertook cross-sectional surveys, markets surveys, and reviewed legislation and enforcement practices around non-standard helmets. Findings 5563 helmet-wearing motorcyclists were observed; 54% of the helmets did not appear to have a marker/sticker indicating that the helmet met required standards and interviewers judged that 49% of the helmets were likely to be non-standard helmets. 5088 (91%) of the motorcyclists agreed to be interviewed; those who had spent less than US

Reducing the burden of injury: an intersectoral preventive approach is needed.

10 on their helmet were found to be at the greatest risk of wearing a non-standard helmet. Data were collected across 126 different retail outlets; across all countries, regardless of outlet type, standard helmets were generally 2–3 times more expensive than non-standard helmets. While seven of the nine countries had legislation prohibiting the use of non-standard helmets, only four had legislation prohibiting their manufacture or sale and only three had legislation prohibiting their import. Enforcement of any legislation appeared to be minimal. Interpretation Our findings suggest that the widespread use of non-standard helmets in low- and middle-income countries may limit the potential gains of helmet use programmes. Strategies aimed at reducing the costs of standard helmets, combined with both legislation and enforcement, will be required to maximise the effects of existing campaigns.

The Road Traffic Injuries Research Network: a decade of research capacity strengthening in low- and middle-income countries

The BoD project is one of some 32 cluster-based multi-departmental cabinet committee work streams typically led by a single provincial government department. Linkages across clusters are difficult to establish, but ostensibly occur at higher levels in sector co-ordinating and top management committees, which report to Cabinet.

PW 2774 The road traffic injury research network (RTIRN): 2 decades of building capacity in low- and middle-income countries

Road traffic crashes have been an increasing threat to the wellbeing of road users worldwide; an unacceptably high number of people die or become disabled from them. While high-income countries have successfully implemented effective interventions to help reduce the burden of road traffic injuries (RTIs) in their countries, low- and middle-income countries (LMICs) have not yet achieved similar results. Both scientific research and capacity development have proven to be useful for preventing RTIs in high-income countries. In 1999, a group of leading researchers from different countries decided to join efforts to help promote research on RTIs and develop the capacity of professionals from LMICs. This translated into the creation of the Road Traffic Injuries Research Network (RTIRN) – a partnership of over 1,100 road safety professionals from 114 countries collaborating to facilitate reductions in the burden of RTIs in LMICs by identifying and promoting effective, evidenced-based interventions and supporting research capacity building in road safety research in LMICs. This article presents the work that RTIRN has done over more than a decade, including production of a dozen scientific papers, support of nearly 100 researchers, training of nearly 1,000 people and 35 scholarships granted to researchers from LMICs to attend world conferences, as well as lessons learnt and future challenges to maximize its work.

PA 03-5-2229 Unintentional injuries in children and gender inequalities: analysis of a longitudinal cohort across four developing countries

The central objective of the Road Traffic Injury Research Network (RTIRN) is to support the development and strengthening of research agendas and research capacity on road traffic injury in low- and middle-income countries. Specifically, the network advocates for research to reduce the burden of road traffic injuries in low- and middle-income countries; develops capacity for road traffic injury research in low- and middle-income countries; promotes investments for road traffic injury prevention; facilitates communication between partners involved in road traffic injury research; conducts strategic road safety research, and promotes the application and utilization of research for policy and intervention development in order to reduce the burden of road traffic injury in low- and middle-income countries. The RTIRN has worked mainly in Africa, Latin America, and Asia to build capacity through training and mentoring, and the funding of strategic research in a number of countries. Through linkages facilitated by RTIRN, partners from both low- and high-income countries were able to successfully build research capacity with limited resources. The Network plans to use various platforms to engage its membership in discussions that highlight research gaps for the road safety field, in order to identify what research is critical where. We intend to interrogate the role of Implementation Research in the face of increasing pressure for Low- and Middle-Income Countries to meet global targets, and adopt recommended road safety interventions, many of them developed in HICs. We invite new and existing partners to join the discussions on www.rtirn.net.

29 Capacity development to link the evidence base to improving regulation in road traffic injury prevention

Injury is a significant cause of death and morbidity among children from the age of one, increasing to become the leading cause of death among children aged 10 to 19 years. Adolescents, particularly girls and young women, are increasingly seen as driving forces in global health and yet are a neglected cohort. There is a growing consensus on the need for investments in adolescent health if the UN’s Sustainable Development Goals and the Global Strategy for Women’s, Children’s and Adolescents’ Health are to be achieved. Increasing globalization has resulted in shifting patterns of exposure to injury-related risk factors. These trends, particularly the impact on reshaping the role of girls and women have not been fully explored in LMIC mainly due to lack of suitable data. Increasingly girls/women are entering the workforce, suggesting that traditional injury patterns and risk-factor exposures are changing. The Young Lives study provides unique longitudinal household cohort data over a 15 year period (2002–2017) in four developing countries (Vietnam, Peru, Ethiopia and India) recruiting ˜2000 children per country in the younger cohort (0–15 years) and 1000 in the older cohort (8–22 years). Data pertaining to injuries incorporates a wealth of information on risk factors such as age, gender, education, cause, activity at time of injury and on household risk factors pertaining to maternal/caretaker health, education and income. This research provides an analysis of childhood injuries across the lifespan of the cohort examining cross-country differences and the changing trends/impact of injuries on girls/women over their lifespan (risk-taking, rough play, employment, health-seeking behaviour after injury). It examines links between chronic maternal health (including mental health) and risk of child injury. Such an analysis will identify gender inequalities during adolescence and examine what causes such inequalities to shift or persist in different ways within and between countries.

La prevención de las lesiones y la consecución de la salud del niño y del adolescente

Background To support country work to improve national regulation on road traffic injury prevention, we developed various approaches and tools to enhance the capacity of staff in government and civil society organisations, mainly lawyers, to assess and develop evidence-based regulations. We use the term “regulation” in this presentation broadly to include laws that are enacted by national parliament and regulations issued by national or subnational ministerial or other executive branches of government. Methods This presentation describes the approaches used to improve the skills, access to and use of evidence-based interventions to assess and improve regulations on road traffic injury prevention for lawyers and others involved in regulatory processes in public health or road traffic. Results Since 2010, WHO has supported the improvement of road safely legislation in 12 countries with support from Bloomberg Philanthropies. In the early years of the capacity development programme (2012–2014), participants from 9 countries (Brazil, Cambodia, China, India, Kenya, Mexico, Turkey, Russian Federation, Viet Nam) were selected through a nomination process from WHO Regional and Country Offices. This phase focused primarily on providing face-to-face periodic training on skills and information on evidence-based road safety interventions. Starting in 2015 we launched a Legal Development Programme in 4 countries (China, Philippines, Thailand, United Republic of Tanzania) with the objectives of providing a range of learning opportunities for lawyers and other individuals involved in developing regulations and of improving their skills, access to and use of resources on evidence interventions to assess and develop evidence-based regulation. Participants were selected through a semi-competitive process taking into consideration their background, interest in the topic, the nature and extent of their involvement in public health or road safety regulation, and commitment to play an active role in improving legislation in public health or road safety in their country. The level of engagement of the Legal Development Programme members in regulatory mechanisms on the topic in country has also been enhanced. Conclusions During 2012–2014 participants who regularly took part in face-to-face workshops showed longer-term and active involvement in improving road safety regulation in their country. Countries supported also showed better improvement in evidence-based regulation (either in the number of changes or in the extent to which the changes are in line with evidence). Although the impact of the Legal Development Programme has not yet been assessed, it has so far generated greater interest than the previous capacity development programme (through an increase in number of participating members since the launch) as well as more active involvement in various aspects of the road safety regulatory process.

World Report on Child Injury Prevention

Introduction Urgent attention is required to tackle the problem of child and adolescent injury across the world. There have been considerable shifts in the epidemiological patterns of child deaths; while great progress has been made in preventing infectious diseases, the exposure of children and adolescents to the risks of injury appear to be increasing and will continue to do so in the future. The international focus of child health interventions has been on reducing mortality of children aged less than 5 to achieve the Millennium Development Goals. This has meant that the 5-18-year age group, in which injuries constitute a great burden, has received less attention. Indeed across the whole age spectrum of childhood and adolescence, the issue of child and adolescent injuries is often absent from discussions and is largely invisible in policies. In December 2008, WHO and the United Nations Childrens Fund published the first Worm report on child injury prevention) calling attention to the problem internationally. The report focused on the five leading causes of child injury deaths--road traffic injuries, drowning, poisoning, burns and falls--and set out what can be done to prevent these injuries. This article expands on the reports arguments that child injuries must be integrated into child health initiatives and proposes some initial steps for achieving this integration. The importance of child injury Injury is a significant cause of death and morbidity among children from the age of one, (1) and increases to become the leading cause of death among children aged 10 to 19 years (Fig. 1). Each year approximately 950 000 children aged less than 18 years die as a result of an injury or violence. Nearly 90% of these--about 830 000--are due to unintentional injuries--about the same number that die from measles, diphtheria, polio, whooping cough and tetanus combined. Most of these unintentional injuries are the result of road traffic crashes, drowning, burns, falls and poisoning, with the highest rates occurring in low-income and middle-income countries (Table 1). In addition to these deaths, tens of millions more children sustain injuries that do not kill them but are serious enough to require hospital treatment and sometimes result in disability. The importance of child injury can be obscured by a focus on the major causes of mortality of children aged less than 5, which in most of the worlds countries do not include injury. Even in regions where injury deaths are known to be underreported and child survival is determined mainly by perinatal causes, lower respiratory infections, diarrhoeal disease, malaria and measles, child injury has an impact on mortality rates of children aged less than 5 and comprises a substantial proportion of child deaths after the age of 5 years. In countries that have made substantial progress in eliminating or reducing childhood deaths from other causes, however, child injury clearly emerges as a major problem. For example in high-income countries, unintentional injuries account for nearly 40% of all child deaths, even though these countries generally have substantially lower child injury fatality rates than low- and middle-income countries. (1) An example from Bangladesh illustrates the point of the relative position of injuries compared with other causes of death. Long-term trend data from the Matlab community laboratory are available for the period 1974 to 2000. Drowning has always been a significant cause of death and in the pre-immunization era, it killed as many children aged less than five as measles. When vaccine-preventable causes were virtually eliminated, drowning rates remained much the same. The relative proportion of drowning mortality has thus increased, rising from 9% of deaths in l-4 year-olds in 1983 to 53% in 2000. (2,3) Why must we act now? Data show clearly that child injuries take an unacceptably high toll on childrens health and development and on society (Box 1). …