Public health crisis of road traffic accidents in India: Risk factor assessment and recommendations on prevention on the behalf of the Academy of Family Physicians of India

Road traffic injuries (RTIs) in children and adolescents in India: an overview of epidemiology, reported reasons and its implications

INTRODUCTION

Road traffic injuries (RTIs) rank among the top causes of mortality and disability in children and adolescents, resulting in substantial socioeconomic impacts.

METHODS

We conducted a narrative review to understand the epidemiological scenarios (gender and state variation), vulnerabilities, interconnected reported reasons, impact and implications of RTI especially among children and adolescents in India using National Crime Record Bureau (2000-2022), Ministry of Road Transport and Highways (2000-2022) reports and other published articles and reports (2000-2024). A snowball search strategy was also used to retrieve all relevant published reports and articles.

RESULTS

Children and adolescents under 18 years accounted for over 8% of all age groups experiencing road crash fatalities in India. Males under 18 years were found to be disproportionately affected by RTIs. Global Burden of Disease recorded a decline in disability-adjusted life years for RTIs among the population aged 5-19 years from 266.7 per 100 000 in 2001 to 157.6 per 100 000 in 2019, with males exhibiting a more significant reduction compared with females. Multiple reasons have been attributed including higher exposure of males, more risk-taking behaviour among males compared with females. It is also observed that RTI related deaths contribute 45% of all injuries, of that pedestrian casualties make up one-third of child fatalities. Chhattisgarh, Odisha, Madhya Pradesh and Maharashtra have recorded higher population-adjusted RTI death rates.

CONCLUSION

Despite the presence of enforcement laws and policies in India, there remains a significant gap in our national programme for integrating context-specific interventions aimed at educating children and parents about safer road use.Additionally, it is crucial to prioritise infrastructure enhancements and strengthen regulatory enforcement. Artificial intelligence presents a valuable opportunity to predict RTIs by accounting for state-specific characteristics, offering a promising tool for developing targeted prevention and intervention strategies.

State-wise economic burden of road traffic injuries in India

BACKGROUND

Road traffic injuries (RTI) cause multifarious detrimental consequences, including fatality and serious injuries. RTIs cause considerable financial strain on healthcare systems with high costs of medical care, long-term care for the injured and lost productivity. To assess this economic burden, we estimated the state-wise economic costs of RTI in India.

METHODS

We followed the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Checklist 2022 to present the methods and outcomes. Data were obtained from the Global Burden of Diseases, Injuries and Risk Factors Study, Government of India's budget documents, annual reports of the National Health Authority, Controller General of Accounts and Economic Surveys. Cost per disability-adjusted life years (DALY), direct costs, indirect costs and total costs associated with RTI burden were estimated for India and by its states.

RESULTS

The RTI burden declined in all Indian states except Jammu and Kashmir (with a minor increase from 1458 to 1564 DALYs per 100 000) and Rajasthan (from 1275 to 1394 DALYs per 100 000) during the 2010-2019 period. The estimated mean cost per DALY in India due to RTI was ₹1821 (95% CI 1606 to 2036) (US$22 (95% CI 19 to 24)), with a median (IQR) of ₹1609 (551) (US$19 (7)). As of 2019, the estimated mean total cost of RTI burden in India was ₹1017 billion (US$12 billion), with a median (IQR) of ₹731 billion (1220 billion) (US$9 billion (15 billion)).

CONCLUSION

The burden of RTIs declined across the Indian states during 2010-2019, and the same was not observed with fiscal implications. The study reiterates the need for strategic road safety interventions to ameliorate the socioeconomic and health impacts of RTIs in India.

Clinical Epidemiology of Trauma Patients: A Retrospective Analysis of 3705 Consecutive Patients Treated at a Level I Trauma Center

BACKGROUND

Trauma is a leading cause of morbidity and mortality globally, particularly in low- and middle-income (LMIC) countries like India, where road traffic injuries (RTIs) dominate. Despite advancements in medical technology, trauma care remains underdeveloped due to resource limitations, inadequate pre-hospital care, and poor compliance with safety measures. This study aimed to analyze the clinical-epidemiological profile of trauma patients and develop strategies for effective trauma prevention and management.

METHODS

A retrospective review of 3,705 trauma patients admitted to a level I trauma center between July 2018 and June 2024 was conducted. Data on demographics, injury mechanisms, triage priority, treatment outcomes, and resource utilization were analyzed. Patients were managed following Advanced Trauma Life Support (ATLS) protocols, with multidisciplinary care and trauma registry utilization.

RESULTS

RTIs accounted for 67.3% of cases, with two-wheeler accidents being the most common (84.7%). Males comprised 78.3% of patients, with a mean age of 37.5 years. Alcohol intoxication was present in 41.9% of cases. Head injuries (1663/3705; 44.9%) and polytrauma (719/3705; 19.5%) were prevalent, with a mortality rate of 4.0%. ICU admission was required for 58.4% (n=2165) of patients, and of these, 992 (45.8%) needed mechanical ventilation. Of the 2,111 two-wheeler-related accidents, only 33% (696) wore helmets and of the 201 four-wheeler accidents, seatbelts were worn by only 41% (n=83). Low compliance with helmet and seatbelt use exacerbated injury severity.

CONCLUSION

The study emphasizes the critical need for tighter enforcement of seatbelt and helmet regulations, improved pre-hospital care systems, and improved road safety measures. To lower trauma-related morbidity and mortality in India, it is essential to build trauma registries, strengthen the infrastructure for trauma care, and put evidence-based policies into place.

Trends in Road Traffic Injuries Mortality in India: An Analysis from the Global Burden of Disease Study 1990-2021

Road traffic injury (RTI) is one of the most common causes of accidental deaths in India. The study investigates the changes in trends in age-standardised RTI mortality rates in India by sex and age groups, using data from the Global Burden of Disease (GBD) Study 2021. The trend segments are estimated from 1990 to 2021 employing a joinpoint regression model. Additionally, the influence of age, time period, and birth cohort on mortality rate trends was assessed using the age-period-cohort model. Over the past 32 years, the RTI mortality rates have experienced multiple trend segments. RTI mortality rate in the ≤ 14-year-old population has declined remarkably, dropping from 5.71 (4.65 to 6.88) per lakh population in 1990 to 3.66 (3.01 to 4.35) per lakh population in 2010, and further declining to 1.98 (1.65 to 2.37) per lakh population in 2021. The study found a positive correlation between RTI mortality rates and age, with rates consistently lower for women compared to men across all age groups. The variation in RTI mortality rates across Indian states has widened over time, with the coefficient of variation increasing from 30.58% in 1990 to 32.36% in 2010, and further to 35.11% in 2021. Despite efforts, Indian states are unlikely to achieve the goal of halving RTI deaths by 2030, based on 2010 levels. To address this, road conditions and road safety policies aimed at preventing the incidence of RTIs should be further intensified.

A qualitative study to explore traffic police personnel perceptions towards road safety behaviour among young riders in Manipal, India

Road crash injuries are significant public health issues in many low-and middle-income countries. Every year more than 1.35 million people lose their lives due to road crashes, making it one of the leading causes of death worldwide. In 2021, 1.19 million road traffic deaths occurred worldwide. Globally, India accounts for the second-largest number of fatal road traffic crashes. Riders in the age range of 18-25 years contribute to 41.4% of India's total road crash victims. An in-depth understanding of the current traffic density, violations, and behaviours of young riders is essential for enforcement agencies, in particular, the traffic police personnel. Their perspective is relevant as they have a unique position to judge and evaluate the riding behaviours and the efficiency of the existing intervention programmes. Furthermore, their suggestions can be highly effective in developing evidence-based risk reduction programmes. The present study was conducted in Manipal, which is a locality of Udupi district in Karnataka province of Southwestern India. Seventeen in-depth interviews were conducted from October 2018 to January 2019 among traffic police personnel. Thematic analysis was done using ATLAS.ti 8 software to identify, analyse, and report themes within the data. Respondents revealed that in recent times Manipal roads have become unsafe for young riders. Factors such as speeding, using a mobile phone while riding, reckless riding, and overtaking from the wrong side were the main reasons for road traffic crashes. Interventions like the installation of traffic barricades, closed-circuit television cameras, speed breakers, and signboards at the crash hotspots, together with strict enforcement of traffic laws, were suggested by the respondents to reduce crashes. The study findings highlight the importance of traffic police personnel's views in understanding the various determinants for road crashes observed among young riders. Future research can be taken up in other settings with broader age group involvement for the target population. There is a need to establish a coordination committee that can locally organize awareness programmes involving all the stakeholders on road safety to increase the level of risk perception and reduce crashes.

Analysis of factors influencing family support for child safety seat legislation based on Probit-Adversarial Interpretive Structure model

OBJECTIVES

In recent years, China's motorization process has accelerated, urban road traffic has become increasingly complex, and the safety of children has become increasingly prominent. China aims to encourage the use of child safety seats (CSSs) and stipulates in the Law on the Protection of Minors that "Parents or other guardians of minors shall take measures, such as equipping child safety seats." However, the utilization rate of such seats in China is still low (<5%, 2021), an important reason is the lack of mandatory legislation. This study focuses on developing cities in China that do not have mandatory legislation on the use of CSS, explores the factors that families support child seat legislation, and explores the impact of children's feedback on the transmission of values within families and the use of CSS in family decisions.

METHODS

Four hundred and eighty-two subjects in several neighborhoods in Changsha City participated in this survey through an online questionnaire. We use the data to do a Probit analysis to find the influencing factors of parental support for child safety seat legislation, and the Adversarial Interpretive Structure model is used to assess the hierarchy of the influencing factors and the relationship between the influence of internal factors.

RESULTS

The results showed that educational level and children's feedback are root cause factors; monthly family income, number of children, confidence level in CSS, number of cars, and others' behavior are intermediate factors; gender, penalty support, and subjective perception expenditure are surface factors.

CONCLUSION

Finally, the results have focused recommendations for the direction of child safety seat legislation, focused recommendations for law enforcement, advocacy, and educational interventions, and recommendations for installation training before the use of CSS.

Implementation of stroke care & road safety in India: Lessons from Australia

India is home to one-fifth of the world's population and is currently the fastest-growing economy. As the health industry is growing, India needs to develop robust implementation of evidence-based health care addressing the major public health issues. Two of such issues India is grappling with are the establishment of stroke care and the reduction of road accidents. Australia has achieved notable success in implementing stroke care and reducing road accidents. In stroke, Australian initiatives include dedicated stroke units, the development of clinical guidelines, the implementation of acute interventions, the establishment of a national stroke foundation, and the stroke registry. As a result, the combined, primary, and secondary prevention measures, acute treatment, and rehabilitation have reduced the total disease burden of stroke from 2003 to 2023 by 53 per cent, from 7.4 to 3.5 Disability Adjusted Life Years (DALYS) per 1,000 population, which is a 56 per cent decline in fatal burden and 23 per cent decline in non-fatal burden. For road safety, Australia implemented evidence-based practices such as education, legislation including mandatory use of seat belts, and other road safety initiatives. Data show that seat belt use reached 98 per cent in Australia in 2023. Furthermore, about 20 per cent of drivers as well as passengers who were killed in crashes in 2024 did not wear seat belts. The reduction of speed limits in built-up areas, the adoption of monitoring technology, and the clever use of infrastructure are proving to be effective in reducing fatalities and serious injuries. Australia's implementation research can provide valuable insights into the efforts of mitigating the impact of stroke and enhancing road safety in India.

Evaluation of the effectiveness of road safety measures and their impact on the pattern and distribution of extracranial and intracranial hemorrhages in fatal head injury cases in Uttar Pradesh, India

Introduction

In Uttar Pradesh, India, there are many fatal head injuries as a result of road traffic accidents (RTAs). Studying the pattern and distribution of intracranial hemorrhages, a frequent complication of severe head trauma might provide vital information on the efficacy of traffic safety regulations. To improve road safety tactics and lower fatal head injuries in Uttar Pradesh, this study intends to assess the effect of road safety measures on the frequency and distribution of intracranial hemorrhages in fatal head injury patients.

Aim

This study's objective is to assess the influence of current road safety initiatives on intracranial bleeding distribution and patterns in fatal head injury cases in Uttar Pradesh.

Methodology

The 604 RTA cases with head injuries that were brought to the mortuary of the S.R.N. Hospital in Prayagraj for a medical-legal postmortem assessment over the course of a year, from April 2021 to March 2022, make up the entirety of this prospective study. Following receiving institutional ethical approval and informed consent, structured interviews with attendees utilizing a questionnaire were done to gather the data.

Result

The results show that certain traffic safety measures have reduced the frequency of fatal head injuries in RTAs. A decreased incidence of intracranial hemorrhages was linked to improved traffic infrastructure, including well-planned junctions, pedestrian crossings, and distinct bicycle lanes. Similar results were shown in serious head injuries when traffic restrictions including speed limits, seat belt use, and helmet legislation were strictly enforced.

Conclusion

There are still issues with fatal brain injuries from car accidents, despite some encouraging results. Safety legislation violations, a lack of public knowledge, and inadequate enforcement all contribute to the issue. Disadvantaged groups like walkers and users on two-wheelers continue to be especially susceptible. The results of this investigation offer important new understandings of the efficiency of traffic safety measures and their influence on the distribution and pattern of cerebral hemorrhages in Uttar Pradesh, India. The results point to the necessity of improved public education efforts and traffic safety laws. More research and focused interventions are required to address specific risk factors among various road user groups. This will result in a safer driving environment and a decline in catastrophic brain injuries.

Thirty-year trends of triple burden of disease in the adult population of Pakistan

BACKGROUND

The triple burden of disease, i.e. communicable diseases, non-communicable diseases and injuries, has significantly affected the healthcare system of Pakistan during the last three decades. Therefore, this study aims to determine and analyse the 30-year disease burden trends through prevalence, death rates and percentages.

METHODS

The data for the last three decades, i.e. 1990 to 2019, was extracted from the Global Burden of Disease for Pakistan. Percentage change in prevalence and deaths over 30 years was calculated. Poisson regression analysis was performed to evaluate the triple disease burden trends and the incidence rate ratio.

RESULTS

A relative decrease of 23.4% was noted in the prevalence rate of communicable diseases except for human immunodeficiency virus and dengue fever. A relative increase of 1.4% was noted in the prevalence rate of non-communicable diseases. A relative increase of 56.1% was recorded in the prevalence rate of injuries. The prevalence rate ratios of communicable diseases significantly decreased to 0.9796 [95% CI: 0.9887-0.9905], but the prevalence rate of injury increased to 1.0094 [95% CI: 1.0073-1.01145], respectively.

CONCLUSION

Pakistan must take the next steps and develop strategies to decrease this burden and mortality rates in the population to create better outcomes and therefore help the healthcare system overall.

Measuring the Prevalence, Treatment, and Associated Treatment Costs of Injury for Older Adults in India: Insights from the National Longitudinal Aging Study

This cross-sectional analysis of secondary data aimed to examine the injury prevalence, treatment, and associated healthcare expenditure among older adults in India. Longitudinal Aging Study India Wave 1 data for those aged 60+ years comprising sociodemographic characteristics and self-reported major injury, injury mechanism, falls and joint/bone fractures, treatment sought, and out-of-pocket expenditure (OOPE) were analyzed. Descriptive, relative risk, bivariate, and two-part regression model analyses were conducted. Fifteen percent of the 31,464 older adults surveyed had experienced a major injury, 13% a fall and 5% a bone/joint fracture. The risk of injury increased with age and income and was higher for urban residents and females. Seventy-eight percent of those who experienced injury sought medical treatment, 56% needing treatment for a serious fall and 3% undergoing surgery. Higher proportions of females than males required medical treatment for falls and injury-related surgery, yet on average, females were spending less than males for public or private hospital treatment. Injury-related OOPE increased with age and decreased with lower education. Scaling up injury prevention efforts specifically focused on older adults will be vital given the projected growth in the older adult population in India in coming years. Such efforts will prevent unnecessary health impacts and reduce health system utilization and associated individual and family economic burden.

Temporal trends in the incidence and mortality of road injuries in China: Current trends and future predictions

BACKGROUND

China has the highest number of road injury deaths in the world. The aim of this study was to determine the long-term incidence and mortality trends of road injuries in China between 1990 and 2019 and to make projections up to 2030.

METHODS

Incident and death data were extracted from the Global Burden of Disease (GBD) 2019 study and population data were extracted from the GBD 2019 and World Population Prospects 2019 studies. An age-period-cohort framework was used for the analysis.

RESULTS

In 2019, 16.1 million road injuries (age-standardized incidence rate [ASIR]: 991.3/100,000) occurred in China. Between 1990 and 2019, the ASIR of road injuries in China increased by 87.4 %. In 2019, there are 250.0 thousand road deaths (age-standardized mortality rate [ASMR]: 14.79/100,000), and the ASMR decreased by 27.0 % between 1990 and 2019. Period and cohort risks for the incidence of road injuries were increased for both sexes. Period and cohort risks for road injury mortality appeared to increase in recent period and birth cohorts. The ASIR of road injuries was projected to increase in the future, and the ASMR was projected to decrease; however, the ASIR of cyclist road injuries in females was projected to increase in the future. Among road injuries, elderly individuals were projected to have an increasing proportion of occurrence and death. Although the proportion is decreasing, pedestrian road injuries were projected to still account for more than half of road injury deaths in China up to 2030.

CONCLUSIONS

The incidence of road injuries in China has increased overall, while the overall mortality rate has decreased over the past 30 years, and this trend is expected to continue in the future. Effective effort is needed to improve road safety, especially for elderly individuals and female cyclists. In addition, pedestrian road safety also needs to be improved.

A comprehensive examination of the economic impact of out-of-pocket health expenditures in India

More than 50% of health expenditure is financed through out-of-pocket payments in India, imposing a colossal financial burden on households. Amidst the rising incidence of non-communicable diseases, injuries, and an unfinished agenda of infectious diseases, this study examines comprehensively the economic impact of out-of-pocket health expenditure (OOPE) across 17 disease categories in India. Data from the latest round of the National Sample Survey (2017-18), titled 'Household Social Consumption: Health', were employed. Outcomes, namely, catastrophic health expenditure (CHE), poverty headcount ratio, distressed financing, foregone care, and loss of household earnings, were estimated. Results showed that 49% of households that sought hospitalization and/or outpatient care experienced CHE and 15% of households fell below the poverty line due to OOPE. Notably, outpatient care was more burdensome (CHE: 47.8% and impoverishment: 15.0%) than hospitalization (CHE: 43.1% and impoverishment: 10.7%). Nearly 16% of households used distressed sources to finance hospitalization-related OOPE. Cancer, genitourinary disorders, psychiatric and neurological disorders, obstetric conditions, and injuries imposed a substantial economic burden on households. OOPE and associated financial burden were higher among households where members sought care in private healthcare facilities compared with those treated in public facilities across most disease categories. The high burden of OOPE necessitates the need to increase health insurance uptake and consider outpatient services under the purview of health insurance. Concerted efforts to strengthen the public health sector, improved regulation of private healthcare providers, and prioritizing health promotion and disease prevention strategies are crucial to augment financial risk protection.

'The spirit is willing, but the flesh is weak?': systemic unknown-knowns for ergonomics in India

While the worldwide ergonomics community increases its sophistication in solving global problems, specific systemic challenges still plague Indians in urban mega-cities such as Mumbai. This paper aims to highlight the gaps using the knowns-unknowns framework, which exists in the Indian ergonomics community's capability to address such systemic challenges. Within this framework, the epistemological category of 'unknown-knowns' is explicated further using a case study of urban accidental deaths and injuries in Mumbai, India. These systemic casualties are essential to note because they are not only hidden from public awareness but can be avoided by proper ergonomics interventions. The article concludes with four main directions for the Indian ergonomics community in solving systemic problems in terms of, (a) capacity-building, (b) advocacy; (c) developing all realms of ergonomics with particular emphasis on complex systems; (d) developing India-centric pathways for ergonomics as a discipline. Practitioner's summary: This paper aims to highlight gaps in the academic Indian ergonomics community's capacity to solve public systemic problems. An India-centric way forward for awareness, engagement, and academic capacity building is suggested to develop a comprehensive national ergonomics mission.

"Road traffic injury could be minimized when individual road users take more responsibility for their safety and the safety of others": Perception of healthcare workers in Vanuatu

INTRODUCTION

Around 1.35 million deaths are caused by Road Traffic Injuries (RTIs) each year. This study aimed to explore the perceptions of Vanuatu's Health Care Workers (HCWs) regarding the existing preventative strategies for RTI.

MATERIALS AND METHODS

In 2020, this study used qualitative approaches to collect data from HCWs using Focus Group Discussions (FGDs). Study participants were self-identified Ni-Vanuatu HCWs who had been serving for more than 6 months in three main hospitals where the study was conducted and purposive sampling was used to gather the study participants. To guide the FGDs, a semi-structured open-ended questionnaire was created. Thematic analysis was used to processed the data obtained, based on predetermined themes that were based on theory while also enabling the data to determine new themes.

RESULT

From 5 FGDs with 22 HCWs who were emergency nurses, doctors and public health officers, data saturation was reached. The study yielded five main themes and sixteen subthemes. The relevance and trends of RTI, barriers to effective care, pre-hospital management capacity, barriers to pre-hospital care and addressing RTI were among the key subjects. The findings suggest that addressing health institutional leadership and resources will improve prevention of RTIs.

CONCLUSION

Prevention of RTIs is hindered by the lack of health institutional capacities in terms of leadership and resources that include emergency equipment, financial and trained human resources. The health sector should consider developing stronger leadership in road safety to be an essential part of its core business.

Need for social work interventions in the emergency department

This paper reports findings from a qualitative study conducted on the Need for Social work interventions in the Emergency Department (ED) at a large tertiary care center in India. The emergency department is an important social work intervention point for individuals with various psychiatric, medical, and social needs who have little or no additional interaction with social services. Social workers are specially trained to understand the impact of social factors on health outcomes and provide interventions that address social barriers to improving health and accessing community resources; social workers are well prepared to provide services in the emergency department. However, limited research is available to understand the impact of psychosocial services in the emergency department. We aimed to identify areas which require integrated social work services and coordination to address the psychosocial issues within the ED. Interviews with 10 healthcare workers are analyzed thematically. Recurring themes throughout the interviews confirm the need for providing social work interventions to ensure the medical, psychological, and social care needs in the emergency department.

A Survey of Traumatic Brain Injuries from Road Traffic Collisions in a Lower Middle-Income Country

The burden of traumatic brain injury (TBI) from road traffic collisions (RTCs) is great in low-and middle-income countries (LMICs) due to shortfalls in preventative measures, and the lack of relevant, accurate data collection. To address this gap, we sought to study the epidemiology of TBI from RTCs in two LMIC neurosurgical centres in order to identify factors amenable to preventative strategies. A prospective survey of all adult and paediatric cases of TBI from RTCs admitted to Northwest General Hospital (NWGH) and Hayatabad Medical Complex (HMC) over a four-week period was carried out. Data on patient demographics, risk factors, injury details, pre-hospitalisation details, admission details and post-acute care was collected and analysed. A total of 68 patients were included in the study. 18 (26%) of the patients were male and in the 30 to 39 age group. Fifty-two percent were two-wheeler riders and/or passengers. 51 (75%) of the RTCs occurred between 12 noon and 12 midnight and in rural areas (66.2%). The most commonly documented risk factor that led to the RTC was speeding (35.3%). Pre-hospital care was either absent or undocumented. Up to two-thirds of patients were not direct transfers, and most were transported in private vehicles (48.5%) arriving later than an hour after injury (94.1%). Less than half with documented disabilities were referred for rehabilitation (38.5%). There are still gaps in the prevention of TBI from RTCs and in relevant data collection. Data collection systems must be strengthened, and further exploratory research carried out in order to improve the prevention of TBI from RTCs.

Will Smart Improvements to Child Restraints Increase Their Popularity?

In developing countries, child safety seat use remains low, which contributes to the consistently high rate of child injuries and deaths in traffic accidents. In order to protect the safety of child passengers, it is necessary to improve the public acceptance of child restraints. We improved the shortcomings of the traditional child restraints by adding some new features: 1, tightening Isofix automatically; 2, using temperature sensing, a high-temperature alarm, automatic ventilation, and cooling; 3, using pressure sensing, if the child is left alone it will set off the car alarm; 4, voice control to adjust the angle of the backrest; 5, the seat can be folded into the trunk. These functions make human-computer interaction more humane. The authors collected changes in parental acceptance of child restraints using the interview method and questionnaires. We found that acceptance increased significantly after making intelligent improvements to the child restraints. The authors used the Technology Acceptance Model to identify the key caveats influencing users' use of intelligent child restraints. Performance expectations, effort expectations, social influence, convenience, and hedonic motivation positively and significantly impacted the willingness to use intelligent child restraints, so the authors suggest that these points should be emphasized when promoting the product. The current study findings have theoretical and practical implications for smart child restraint designers, manufacturers, sellers, and government agencies. To better understand and promote child restraint, researchers and marketers can analyze how people accept child restraint based on our research model.

A Focus Group Study to Explore Risky Ridership among Young Motorcyclists in Manipal, India

Road crash injuries have emerged as a significant public health issue in many low and middle-income countries in recent years. In India, motorized two-wheelers comprise 70% of the vehicle population and are considered the most vulnerable road users. Road crash injury is common among the young-aged population leading to premature deaths. It is essential to understand risky riding behaviors to develop accurate, evidence-based risk reduction programmes that fit the target population’s characteristics and the intervention setting. The current study aims to improve the understanding of the typical characteristics of motorcycle crashes among young riders in India, primarily focusing on the prevalence and role of risky riding behaviors. Five focus group discussions with eight to ten participants in each group (N = 35) were conducted in Manipal, in the Karnataka state of Southwestern India. A thematic analysis was completed using MAXQDA software to identify, analyze, and report on themes within the data. Speeding, riding under the influence of alcohol, and the poor maintenance of motorcycles were indicated as leading causes of crashes. Furthermore, using mobile phones while riding, violations of the traffic rules, and helmet non-use were identified as other risky behaviors among young riders. Future research can be taken up in other settings for the target population. Generational awareness with the involvement of young riders, government authorities, university officials, and the Regional Transport Office can be initiated. Engaging young riders, government authorities, university officials, and the Regional Transport Office through behavioral interventions such as persuasive communication techniques, an active experimental approach (such as the use of a simulator), and regulating the licensing procedure can reduce the number of road crashes.

An Exploration of Characteristics and Time Series Forecast of Fatal Road Crashes in Manipal, India

Road crashes are the sixth leading cause of death in India. There has been a fourfold increase in the number of road traffic crashes in India in the last four decades and an increase of 9.8 times in the fatalities associated with that exponential increase. Manipal is a coastal place with a population of approximately 50,000 inhabitants lying in between the western Mountain range and the Arabian sea. The study’s objective is to explore the characteristics of fatal road crashes in Manipal from 2008–2018 using the data pertaining to fatal crashes retrieved from the office of the superintendent of police. Furthermore, it aims to forecast crashes by time series analysis prediction. The results show that most of the fatal crashes are due to exceeding the lawful speed limit, followed by driving under the influence of alcohol and going ahead and overtaking. The time series analysis forecasted the number of fatal crashes until the year 2025 and predicted that there will be an increase in the number of fatal road crashes by 4.5%. The results also provide essential leads for initiating specific intervention programmes targeting the causes of fatal road crashes.

Perception of Law Enforcement Officers on Preventing Road Traffic Injury in Vanuatu: A Qualitative Study

Background: Road Traffic Injuries (RTIs) cause approximately 1. 35 million deaths annually, and is the leading cause of death among people between ages 5 and 29. Law Enforcement Officers (LEOs) deal with Road Traffic Collisions (RTCs) and have contact with RTI victims at a daily basis, they possess an excellent perspective on preventing RTI. This study aimed to explore LEOs perceptions on risk factors and preventive measures of RTI in Vanuatu. Methods: This study employed qualitative methods that used Focus Group Discussions (FGDs) to gather data from 25 LEOs between October 14th and November 30th, 2020. Self-identified Ni-Vanuatu LEOs who have been serving for over 6 months and residing at the study setting were included in this study. Purposive sampling was used to recruit study participants from three municipalities in Vanuatu. A semi-structured open ended questionnaire was designed to guide the FGDs. Data obtained were sorted out using thematic analysis processed with some preconceived themes based on theory, and also allowing the data to determine new themes. Results: Data saturation was reached from conducting 5 FGDs with 25 LEOs who were traffic officers and municipal wardens. Five main themes and sixteen subthemes were generated from the study. The main themes include driving and alcohol, the challenges to effective enforcement, barriers to effective care and support for RTI victims, measures for road traffic control and promoting road traffic safety. The respondents perceived that addressing resources issues and the legislations on road traffic control act and vehicle regulation act will enhance prevention of RTI. Conclusion: This study explored the risk factors of RTI and the barriers to effectively prevent RTI in Vanuatu. The study also generated suggestions of a combination of road traffic control measures that could be implemented to prevent RTI. Future research should look at effective strategies of preventing RTIs in resource deficit settings.

Incidence of ocular and systemic diseases affecting visual function among state bus drivers

Purpose:

To evaluate the incidence of ocular and systemic disease affecting visual function among state transport corporation bus drivers in a south Indian district.

Methods:

This retrospective study analysed the records of all the drivers who presented to a south Indian tertiary-care eye hospital in 2019 for their mandatory annual ocular check-up. Details reviewed included demographic details; refraction; presence of systemic and ocular diseases with vision-threatening potential; presence of ocular conditions responsible for visual loss and the treatment administered.

Results:

3042 drivers (mean age, 47.0 ± 5.7 years) were evaluated. Visual function-threatening systemic diseases were present in 25.0% drivers, out of which diabetes mellitus (18.7%) was the most common pathology. The most common ocular problem was refractive error (45.0%). Visual function-threatening ocular diseases were present in 9.5% drivers. Diabetic retinopathy, visually-significant cataract, glaucoma and central serous chorioretinopathy were noted in 4.0%, 1.9%, 1.7% and 0.8% drivers. Surgical intervention was required in 2.2% drivers. Thirteen drivers were temporarily deemed unfit for driving heavy-weight vehicles.

Conclusion:

Several bus drivers suffer from vision-threatening systemic and ocular diseases. Some of them require surgical intervention to retain fitness. A complete ocular and systemic evaluation of diseases with vision-threatening potential should be performed at the time of renewal of the driving license. The drivers should be educated about the systemic diseases which can affect their driving skills and must be encouraged to seek medical help at an early stage.

Prevalence and determinants of posttraumatic stress disorder and depression among survivors of motor vehicle accidents from a hilly Indian state

BACKGROUND

Motor vehicle accidents (MVAs) are the leading cause of death and have also been proven debilitating for their survivors. In India, with poor road infrastructure and low maintenance, MVAs are quite apparent. With a significant focus of treatment on physical health, psychological consequences linked to these traumas are often neglected.

AIM

The aim of this study was to estimate the prevalence of posttraumatic stress disorder and depression, as well as the determinants of these disorders among survivors of MVAs.

MATERIALS AND METHODS

An institution-based, cross-sectional descriptive study was conducted among 250 survivors of MVA visiting a tertiary care center in Uttarakhand (India) during December 2019, recruited using total enumerative sampling. Data were collected with standardized and validated tools that consisted of sociodemographic information, Posttraumatic Stress Disorder Checklist 5, and Zung Self-Rating Depression Scale. Data were analyzed using SPSS version 23, including descriptive (frequency, percentage, mean, and mean percentage) and inferential statistics (Mann-Whitney, Kruskal-Wallis, and binary logistic regression).

RESULTS

The prevalence of posttraumatic stress disorder (PTSD) was found to be 32.4%, and mild and moderate depressions were present among 14.4% and 6.4% of the study population, respectively. Witnessing death (odds ratio [OR] = 5.52; 95% confidence interval [CI] = 0.92-3.06), loss of valuables (OR = 2.62; 95% CI = 0.78-9.04), self-blame (OR = 6.06; 95% CI = 1.15-31.91), and perceived death threat (OR = 9.98; 95% CI = 5.89-46.85) acted as determinants in the occurrence of PTSD and depression.

CONCLUSION

A considerably large proportion of the population suffered from psychiatric disorders following the trauma. These must be addressed with an urgent development of multidisciplinary teams incorporating mental health services across all hospitals' trauma units.

An exploratory qualitative study of the prevention of road traffic collisions and neurotrauma in India: perspectives from key informants in an Indian industrial city (Visakhapatnam)

BACKGROUND

Despite current preventative strategies, road traffic collisions (RTCs) and resultant neurotrauma remain a major problem in India. This study seeks to explore local perspectives in the context within which RTCs take place and identify potential suggestions for improving the current status.

METHODS

Ten semi-structured interviews were carried out with purposively selected key informants from the city of Visakhapatnam, Andhra Pradesh. Participants were from one of the following categories: commissioning stakeholders; service providers; community or local patient group/advocacy group representatives. Transcripts from these interviews were analysed qualitatively using the Framework Method.

RESULTS

Participants felt RTCs are a serious problem in India and a leading cause of neurotrauma. Major risk factors identified related to user behaviour such as speeding and not using personal safety equipment, and the user state, namely drink driving and underage driving. Other reported risk factors included poor infrastructure, moving obstacles on the road such as other vehicles, pedestrians and animals, overloaded vehicles and substandard safety equipment. Participants discussed how RTCs affect not only the health of the casualty, but are also a burden to the healthcare system, families, and the national economy. Although there are ongoing preventative strategies being carried out by both the government and the community, challenges to successful prevention emerged from the interviews which included resource deficiencies, inconsistent implementation, lack of appropriate action, poor governance, lack of knowledge and the mindset of the community and entities involved in prevention. Recommendations were given on how prevention of RTCs and neurotrauma might be improved, addressing the areas of education and awareness, research, the pre-hospital and trauma systems, enforcement and legislation, and road engineering, in addition to building collaborations and changing mindsets.

CONCLUSIONS

RTCs remain a major problem in India and a significant cause of neurotrauma. Addressing the identified gaps and shortfalls in current approaches and reinforcing collective responsibility towards road safety would be the way forward in improving prevention and reducing the burden.

A Reevaluation of the Risk of Infection Based on Time to Debridement in Open Fractures: Results of the GOLIATH Meta-Analysis of Observational Studies and Limited Trial Data

BACKGROUND

Open fractures are one of the leading causes of disability worldwide. The threshold time to debridement that reduces the infection rate is unclear.

METHODS

We searched all available databases to identify observational studies and randomized trials related to open fracture care. We then conducted an extensive meta-analysis of the observational studies, using raw and adjusted estimates, to determine if there was an association between the timing of initial debridement and infection.

RESULTS

We identified 84 studies (18,239 patients) for the primary analysis. In unadjusted analyses comparing various "late" time thresholds for debridement versus "early" thresholds, there was an association between timing of debridement and surgical site infection (odds ratio [OR] = 1.29, 95% confidence interval [CI] = 1.11 to 1.49, p < 0.001, I2 = 30%, 84 studies, n = 18,239). For debridement performed between 12 and 24 hours versus earlier than 12 hours, the OR was higher in tibial fractures (OR = 1.37, 95% CI = 1.00 to 1.87, p = 0.05, I2 = 19%, 12 studies, n = 2,065), and even more so in Gustilo type-IIIB tibial fractures (OR = 1.46, 95% CI = 1.13 to 1.89, p = 0.004, I2 = 23%, 12 studies, n = 1,255). An analysis of Gustilo type-III fractures showed a progressive increase in the risk of infection with time. Critical time thresholds included 12 hours (OR = 1.51, 95% CI = 1.28 to 1.78, p < 0.001, I2 = 0%, 16 studies, n = 3,502) and 24 hours (OR = 2.17, 95% CI = 1.73 to 2.72, p < 0.001, I2 = 0%, 29 studies, n = 5,214).

CONCLUSIONS

High-grade open fractures demonstrated an increased risk of infection with progressive delay to debridement.

LEVEL OF EVIDENCE

Prognostic Level IV. See Instruction for Authors for a complete description of the levels of evidence.

Clinicoepidemiological profile of trauma patients admitting to the emergency department of a tertiary care hospital in eastern India

Context:

Trauma is an immediate cause of patients flowing to the emergency department of any hospital. Besides epidemiology, clinical profile and treatment strategy forms an important aspect to reflect the gap in the existing public sector health-care system and the requirement.

Aims:

To evaluate the clinicoepidemiological profile of trauma patients admitting to an apex trauma hospital in east India.

Settings and Design:

A prospective observational study was performed during the time period of December 2018 to July 2019 on trauma patients admitted to the Trauma and Emergency department.

Methods and Material:

Patient's demographic profile, injury type, mechanism, the vehicle involved in the accident, and transportation were recorded. Various trauma scores (clinical) and outcome measures were recorded.

Statistical Analysis Used:

Statistical analysis was done by R version 3.6.1.

Results:

Male: female ratio was 407:93 with the 21–30 age group predominantly. 2–6 PM was the most common time of injury and ambulance was the predominant mode of transport (58%). Road traffic injury (RTI) accounted for 75% victims; two-wheelers (68%) dominated over others. Thirty percent (drivers 18%, pillion riders 12%) were wearing helmet; 41% were wearing seat belts (drivers 34%, passenger 12%). Twenty-five percent of drivers consumed alcohol. The median ± Interquartile range of injury severity score (ISS), revised trauma and trauma score and injury severity score were 17 (11–26), 7.8 (4.1–7.8), and 98.41 (95.95–99.30), respectively. Extremity injury (54% fractures) and head injury (50%) were the frontrunners in the pattern of injury, with half of the victims were polytrauma (ISS > 15).

Conclusions:

The injury was prominently RTI and the trauma victims/patients were young male drivers on two wheelers. The focus should be directed to make use of safety measures among the youth.

Incidence and pattern of road traffic injuries in tribal population of Jharkhand: One-year study in a tertiary care teaching hospital

BACKGROUND AND AIM

Road traffic injuries (RTIs) are a leading cause of mortality and morbidity globally. This study aimed to assess the incidence and pattern of RTIs in the tribal population of Jharkhand.

METHODS AND MATERIALS

This prospective observational study was conducted for a period of 1 year (June 2018 to May 2019) at the Rajendra Institute of Medical Sciences, Ranchi, Jharkhand. A pretested semi-structured questionnaire was administered. A total of 1713 road traffic accident (RTA) victims belonging to tribal population were interviewed during the study period. Data were entered in a Microsoft Excel sheet and analyzed using Statistical Package for Social Sciences (SPSS) version 16.

RESULTS

There were 1258 (73.4%) males and 455 (26.6%) females. The majority (31.4%) of patients belonged to the age group of 21-30 years, followed by 19.2% in the age group of 31-40 years. The majority (52.13%) of RTAs involved a two-wheeler vehicle. Head injury was the most common type of injury (40.86%), followed by lower limb injury (26.68%). Common upper limb injuries were in the humerus and radius and ulna region. The majority of lower limb injuries involved tibia and femur. Common thoracic-abdomen injuries were soft tissue injury and lung contusion. Drunk driving (alcohol influence) was seen in 34.68% of cases of RTI.

CONCLUSIONS

RTA is a major public health problem which needs to accelerate the efforts of road safety preventive measures. Road safety education should be promoted.

The effect of 'THE MOTOR VEHICLES (AMENDMENT) ACT, 2019' on the clinico-epidemiological profile of road traffic accident patients presenting to a tertiary care trauma centre in Bhubaneswar

CONTEXT

Road traffic accidents (RTA) are a foremost rising cause of morbidity and mortality in developing countries like India. The Government of India enacted a new motor vehicle amendment act (MVA) on September 1st 2019 that permits heavy penalties for traffic rule offenders.

AIMS

To find out the early impact of "THE MOTOR VEHICLES (AMENDMENT) ACT, 2019".

SETTINGS AND DESIGN

A retrospective observational study was performed during the time period July to October 2019 on RTA patients admitted to the Trauma and Emergency department.

METHODS AND MATERIALS

Patients studied in two groups - One Pre MVA group (n = 371) and one Post MVA group (n = 415). The data were extracted from medical case records of the department and filled up in a structured format. Detailed demographic profile, including the use of safety measure and clinical variables such as the pattern of injury and injury severity scores, were recorded.

STATISTICAL ANALYSIS USED

Statistical analysis was done by R version 3.6.1.

RESULTS

There is a 41% drop in RTA victims post MVA implementation. Polytrauma reduced (25% vs 45.5%) significantly (P = 0.002) and so was Injury severity score (6.00 vs 13.00). More RTA victims were wearing helmets as compared to previous (42% vs 18%), and there was a steep decline in the alcohol driving (25% vs 10%) between the pre and post MVA group. A significant reduction noted in the under 18 yrs. Two-wheeler riders in the post MVA group compared to earlier (P = 0.016).

CONCLUSIONS

The study reveals that there is a commendable reduction in the injury severity, violation of safety gears, alcohol use and rash driving following the implementation of MVA September 2019. Primary care and family physician can play a crucial role in creating public awareness about the personal safety measures, which will help in strengthening of this law to reduce the incidence of RTA and the associated mortality and morbidity.

Hospital-Based Case Series Analysis of Road Traffic Trauma Patients in Sri Lanka

Road traffic accidents claim many lives each year worldwide and cause significant disability among survivors. Resulting socioeconomic burden is severe in low- and middle-income countries. Global emphasis currently focuses on trauma education and prevention in addition to improving post-injury care. Sri Lankan government recently made compulsory legislation to improve the safety standards of imported motor vehicles. Such regulations would not directly protect vulnerable road users (VRUs) who form the main bulk of Sri Lankan and South Asian automobile trauma casualties. With the objective of reviewing the management outcome of automobile trauma in order to correlate the potential impact of new legislation on injury prevention, data of all admitted road traffic injury victims were audited for 2 months. Out of 473 eligible cases (332 (70.2%)—males; mean age 37.2 years), there were 14 (3%) fatalities. Of 459 (97%) survivors, 77 (16%) suffered major injuries. Twelve out of 14 (85.7%) fatalities, 64 of 77 (83.1%) survivors with major injuries and 263 of 382 (68.8%) cases of lesser injuries were VRUs (p value = 0.02: chi-square). VRUs had a significantly higher mean Injury Severity Score (ISS) of 10.96 ± 8.43 SD than non-VRUs who had a mean ISS of 8.14 ± 6.04 SD (p = 0.003: t test). Among all survivors, 33/39 (84.6%) with permanent disability, 95/110 (86.4%) with temporary disability and 199/310 (64.2%) with no residual disability were VRUs (p value < 0.0001: chi-square). Of 222 drivers/riders, 45 (20.3%) had consumed alcohol prior to the incident and 20 (9%) were driving without a valid licence. Thirty-four out of 162 (21%) motor bike travellers were not wearing a protecting helmet. Results denote that VRUs suffer significant majority of the fatalities and major injuries after road traffic trauma and to have higher residual temporary/permanent disability among survivors. Recent compulsory motor vehicle safety measures are unlikely to directly protect majority of automobile trauma victims in Sri Lanka. To obtain a higher impact on road traffic injury prevention, main emphasis has to be given to improve the safety standards of VRUs in developing countries.

First responder's care package on management of road traffic accident victims of Udupi: Study protocol

AIM

To evaluate the effectiveness of 'first responder's care package' on knowledge and skill on the management of road traffic accident (RTA) victims. The outcomes relate to the quality of first responder's care by autorickshaw drivers.

METHODS

Autorickshaw drivers (N = 1,040) will be assessed to identify the impediments and knowledge to provide the first responder's care to RTA victims following which, 150 autorickshaw drivers will be selected based on a cut-off knowledge score to train half of them using workshops. Drivers below 55 years and willing to participate will be recruited and drivers with serious health issues, homophobia and who cannot read English or Kannada will be excluded. Randomized controlled trial with repeated measures design will be adopted. Funding for the research is by the Indian Council of Medical Research and it is registered in the Clinical Trial Registry of India.

DISCUSSION

Road traffic accidents are responsible for 85% of the total global mortality and 90% of the 'Disability Adjusted Life Years' in the developing countries amounting to an annual loss of $65 billion to $100 billion. India's rate of RTA deaths is high and postcrash care is not addressed efficiently by any agencies in India. Autorickshaw drivers could be ideal candidates for teaching the first responder's care package in India as they are a constant presence on the roads and reach all the main roads and small lanes of the country.

IMPACT

The research will add to knowledge on quality of first responder's care provided to accident victims. If the intervention is found to be fruitful for the accident victims of the locality, it can be recommended to be implemented all over the state.

Safer Roads to School

Any and all advances made by medical science cannot solve the problem of road traffic injuries (RTIs) in school-going children, especially if the only concerned people are those of the medical fraternity. Children are a vulnerable part of the traveling population and thus have been persistent due to the callous nature of the citizens and policy makers toward road safety and injury prevention. In our multicultural and multilingual country, there is a need for multistakeholder initiative with a countrywide presence if we are to stem the rise of mortality and morbidity due to these accidents. The first question we need to ask is how to prevent road traffic accidents and improve the condition of our roads. Pediatric RTIs are eternal problem of industrial revolution with complications and effects that may affect individual and society with increase in the number of motorized communications. Dedicated capacity building is urgently need who should be able to provide the necessary care to the injured children at the road crash spot as well as should be informed where to take the injured child and whom to contact in the dedicated injury care center while transporting the victims of situations.

Assessment of road traffic behavior using Youth Risk Behavior Survey questionnaire among school-going adolescents of Jaipur city, Rajasthan: An observational analysis

Background:

Adolescents are a relatively healthy group, but their developmental stage makes them vulnerable to many risk-taking behaviors. One such major issue is road safety practices and their risk on roads.

Objective:

To determine road safety risk behavior among school-going adolescents of Jaipur city and factors associated with it.

Materials and Methods:

An observational, cross-sectional study was conducted from July 2015 to February 2016. A total of 900 school-going adolescents were enrolled from eight schools of Jaipur city and the Youth Risk Behavior Survey (YRBS) questionnaire was administered.

Results:

Most of the participants (67.56%) were in the age group of 13–16 years. A total of 682 (75%) adolescents were driving one or other type of vehicle to commute. Out of the 682 vehicle-using adolescents, 603 (88%) had risky behavior on roads. Driving under the influence was found more among those using four-wheelers (10%) than two-wheelers (5%). Almost half of drivers used mobile phones while driving a car or two-wheeler. There was statistically significant association between risk on roads with respect to rising education and occupation of parents. A majority (88.41%) of the school-going students were found to be at risk on roads while driving. Safety-belt was not used by 28% of the students while half did not use a helmet. More than 70% of the car drivers and two-wheeler drivers drove without license.

Conclusion:

Majority of the adolescent drivers are at risk on roads. Driving without license and/or helmet and using mobile phone are the main risk factors.