Background:Road Traffic Accident (RTA) is one among the top five causes of morbidity and mortality in South-East Asian countries.(1) Its socioeconomic repercussions are a matter of great concern. Efficient addressing of the issue requires quality information on different causative factors.Research Question:What are different epidemiological determinants of RTA in western Nepal?Objective:To examine the factors associated with RTA.Study Design:Prospective observational.Setting:Study was performed in a tertiary healthcare delivery institute in western Nepal.Participants:360 victims of RTA who reported to Manipal Teaching hospital in one year.Study Variables:Demographic, human, vehicular, environmental and time factors. Statistical analysis: Percentages, linear and logarithmic trend and Chi-square.Results:Most of the victims i.e. 147 (40.83%) were young (15 to 30 years); from low i.e. 114 (31.66%) and mid i.e. 198 (55%) income families and were passengers i.e. 153 (42.50%) and pedestrians i.e. 105 (29.16%). Sever accidents leading to fatal outcome were associated with personal problems (P<0.01, χ2 - 8.03), recent or on-day conflicts (P<0.001, χ2 - 18.88) and some evidence of alcohol consumptions (P<0.001, χ2 - 30.25). Increased prevalence of RTA was also noticed at beginning i.e. 198 (55%) and end i.e. 69 (19.16%) of journey; in rainy and cloudy conditions (269 i.e. 74.72%) and in evening hours (3 to 7 p.m. 159 i.e. 44.16%). Out of 246 vehicles involved; 162 (65.85%) were old and ill maintained. The contributions of old vehicle to fatal injuries were 33 (50%). Head injury was found in 156 (43.33 %) cases and its associated case fatality rate was 90.90%. In spite of a good percentage receiving first aid i.e. 213 (59.16%) after RTA; there was a notable delay (174 i.e. 48.33% admitted after 6 h) in shifting the cases to the hospitals. The estimated total days lost due to hospital stay was 4620 with an average of 12.83 days per each case.Conclusion:Most of the factors responsible for RTA and its fatal consequences are preventable. A comprehensive multipronged approach can mitigate most of them.