Nicole Toomey

Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries

Background Road traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world’s road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap. Methods In accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes. Results Of the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention. Conclusion Legislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the impact of improvements will affect speed and traffic flow. Further road traffic injury prevention interventions should be performed in LMICs with patient-centered outcomes in order to guide injury prevention in these complex settings.

Road traffic injury in sub-Saharan African countries: A systematic review and summary of observational studies

ABSTRACT Objective: The aim of this study is to evaluate, through a systematic review of hospital-based studies, the proportion of road traffic injuries and fatalities in sub-Saharan Africa (SSA). Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology guidelines, we searched the following electronic databases: PubMed, Embase, Africa-Wide Information, Global Health, and Web of Science. Articles were eligible if they measured proportion of road traffic injuries (RTIs) in SSA by using hospital-based studies. In addition, a reference and citation analysis was conducted as well as a data quality assessment. Results: Up to 2015, there were a total of 83 hospital-based epidemiologic studies, including 310,660 trauma patients and 99,751 RTI cases, in 13 SSA countries. The median proportion of RTIs among trauma patients was 32% (4 to 91%), of which the median proportion of death for the included articles was 5% (0.3 to 41%). Conclusion: The number of studies evaluating RTI proportions and fatalities in SSA countries is increasing but without the exponential rise expected from World Health Organization calls for research during the Decade of Action for Road Traffic Injuries. Further research infrastructure including standardization of taxonomy, definitions, and data reporting measures, as well as funding, would allow for improved cross-country comparisons.

Erratum: Road traffic injury prevention initiatives: A systematic review and metasummary of effectiveness in low and middle income countries (PLoS ONE (2016) 11:1 (e0144971) DOI: 10.1371/journal.pone.0144971)

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612 The effect of household size on injury risk factors in Southern Brazil

Background The neighbourhood an individual lives in affects their injury risk. In Brazil, males of minority races with low education have the highest risk for injury. Family is an important aspect of Brazilian culture; however there is little research on how family structure affects injury risk. This preliminary analysis investigates the association between household size and risk for types of injuries. Methods Information on household demographics was collected in a survey on treatment-seeking behaviour following injury in Maringá, Brazil between May and September 2015. The prevalence of demographic factors, including insurance status, mode of transportation to health care, and education level, as well as reasons for not seeking care, were analysed by three categories of household size: 2 or fewer individuals, 3 to 5 individuals, and 6 or more individuals. Frequencies, range, and odds ratios were reported. Results Of 2678 households, the mean household size was 3.39 (r 1–15). As household size increased, enrollment in private insurance decreased; 50.5% of households of 2 or fewer had private insurance compared to only 27.5% with 6 or more. Alcohol usage prior to injury increased with household size; 5.3% of individuals in households of 2 or fewer reporting use, compared and 9.8% in houses of 6 or more. Large households had higher odds of unspecified injuries (OR: 1.85), including acts of violence, compared to households with 5 or fewer members. Odds of burn decreased with household size increase (OR: 0.833). Conclusions Household size is a component of socioeconomic status; our data shows it is associated with insurance and alcohol usage. Risk of certain injuries is associated with household size. Further research needs to assess where these injuries are occurring, such as work or home. More in-depth research is also needed on how household size affects the family member occupations, as this places them at higher risks for different forms of injuries.

1045 Determinants of treatment seeking behaviour following injury in Maringá, Brazil

Background Injury accounts for 6% of all disability adjusted life years lost. Current research on access to care and injury does not account for injury severity or levels of health care. Our project aims to determine what barriers to injury care arise in Brazil’s universal health care system. Methods Households were randomly selected in Maringá between May 2015 and September 2015. Demographic information was collected for the household; one individual was randomly selected to provide injury history. A chi-square analysis found the association between care-seeking and demographic variables. A preliminary significance level of α = 0.20 was used for inclusion of variables. A full multivariate logistic regression model and thirty reduced models were run. Mean squared estimate and Akaike Information Criterion were calculated to find the best predictive model. Results Of the 2678 households and individuals sampled, 30.3% of individuals reported a lifetime injury. The univariate analysis found that gender (p = 0.034), injury cause (p < 0.001), race (p = 0.051), severity (p = 0.103) and insurance status (p = 0.026) were predictors of seeking care. Income, and age were included in the multivariate model due to significance in the literature. Based on this model, Burn victims had an increased odds of 7.92 of not seeking care compared to road traffic incident victims; this increased odds was also seen when stratifying by gender (OR = 9.49 for women, OR = 8.23 for males). For all injuries, being male had a protective effect on seeking care (OR = 0.64); women had higher odds of not seeking care (OR = 1.30) Conclusions Cause of injury and socioeconomic status factors are a major predictor for seeking care, as are factors related to socioeconomic status. Cause potentially masked the effects of gender on care seeking. More research needs to be done on specific causes of injuries, the role of gender, and why socioeconomic status is still a barrier to care in a universal access system.

559 Examining the relationship between education and alcohol-attributable non-fatal injury risk in brazil

Background In Brazil, alcohol use is a leading risk factor for injury contributing to over 8% of DALYs lost. While alcohol consumption increases with income, there is an inverse risk of alcohol-attributable mortality with socioeconomic status (SES). Education is an important measure of SES; yet its effect on risk for non-fatal injury is unclear. This project investigates education level most at risk for alcohol positive injury in Maringá, Brazil. Methods Self-reported alcohol usage two hours prior to injury was collected during a survey on treatment-seeking behaviour following injury in Maringá, Brazil between May and September 2015. Households provided demographics, and one randomly selected household member supplied injury history. Alcohol usage prior to injury and demographics were analysed using frequencies and logistic regression. Risk ratios were calculated using primary school incomplete, the lowest risk group, as reference. Results Of 2678 people surveyed, 797 reported injury. Only 56 (7.02%) reported alcohol use of which 85.7% were male. Of all alcohol-attributable injured patients, 3 (5.4%) did not complete primary school, 8 (14.3%) completed primary school, 12 (21.4%) completed secondary school, and 15 (26.8%) completed professional school. Those who completed primary education and professional education were at similar risk for alcohol-attributable injuries. Completing primary school (RR = 4.14, p = 0.032) and professional school (RR = 3.43, p = 0.047) had the highest risk of alcohol-induced non-fatal injury. Conclusions Alcohol use is a major risk factor for injury and is influenced by education. While our sample size is small and only includes non-fatal injuries, it mirrors the general pattern of alcohol usage seen in Brazil. We found low and high levels of education were at highest risk for alcohol-related injury. Our data suggests an indirect dependence of education on alcohol-induced injury however this relationship requires more in depth research.