A successful model of road traffic injury surveillance in a developing country: process and lessons learnt

Abstract

BackgroundRoad Traffic Injuries (RTIs) are one of the leading causes of death and disability worldwide with 90% of global mortality concentrated in the low and middle income countries. RTI surveillance is recommended to define the burden, identify high risk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This paper shares the experience of setting up an urban RTI surveillance program in the emergency departments of five major hospitals in Karachi, Pakistan.MethodWe describe the process of establishing a surveillance system including assembling a multi-institution research group, developing a data collection methodology, carrying out data collection and analysis and dissemination of information to the relevant stakeholders. In the absence of a road safety agency, the surveillance system required developing individual partnerships with industry, police, city government, media and many other stakeholders. Impact of the surveillance is demonstrated by some initiatives in the local trauma system and improvements in road design to effect hazard reduction.ConclusionWe demonstrated that a functional RTI surveillance program can be established, and effectively managed in a developing country, despite lack of infrastructure and limitation of resources. Data utilization in the absence of well defined road safety infrastructure within the government is a challenge. More effective actions are hampered by the limited capacity in the transport and health sectors to do in-depth analysis through road safety audits and trauma registries.

Health system and law enforcement synergies for injury surveillance, control and prevention: a scoping review

“…Within the department of Emergency Medicine at the University of New Mexico, a medical resident used analysis of unintentional gunshot fatalities and their associated risk factors to inform the work of the New Mexico Zero Tolerance Team. This community action team which included HS, LE, medical and other stakeholders used a map of childhood firearm deaths to focus community resources on addressing youth firearm fatality prevention 39. Doezema similarly described how a medical resident’s participation in a death review team for domestic violence-related homicide victims resulted in more complete case reports 40…”

“…In Pakistan, LE and physicians collaborated to create and implement a LE-led Emergency Medical Systems (EMS) programme called Rescue 15 46. A different Pakistani programme, in the city of Karachi, established a partnership between hospitals, LE agencies, industry and media and developed a road traffic injury surveillance system and safety-focused road design 39. In addition, HS-LE partnerships are described that expanded to include other stakeholder groups (eg, businesses, insurance providers)39 43 in efforts to develop road traffic injury surveillance partnerships,45 as well as to address injury risk factors like teen driving44 and alcohol consumption 45…”

Variations in sub-national road traffic fatality trends in a low-income country

“…[11] None of the previous international and national reports had compared the sub-national variations of RTF indicators in Pakistan. [14–16]…”

Time Series Analysis of Mortalities Resulting from Car Accidents in the Injured Individuals Hospitalized in Shiraz Shahid Rajaee Hospital During 2010 - 2016

“…A total of 90% of road traffic deaths occur in low-income and middle-income countries. These countries have 82% of the world's population and only have 54% of the world's registered vehicles (7,8). Statistics have shown that 30% to 40% of the deaths and injuries in accidents are due to unauthorized speed in Iran (9).…”