BackgroundDue to its perception as a disease of development, road traffic accident and related injuries tend to be under recognized as a major health problem in developing countries. However, majority of the world's fatalities on the roads occur in low income and middle income countries. Since the main cause of road traffic accident is attributed to human risky behaviors, it is important to identify significant factors for risky behaviors of drivers.MethodsA quantitative cross-sectional study with a sample size of 350 drivers was conducted in April 2011. The study was conducted among Taxi, Bajaj (three tire vehicles) and private owned car drivers. After proportion to size allocation for Taxi (75), Baja (103) and private owned car (172) drivers, we used systematic random sampling method to identify illegible study subjects. Data was collected with face to face interview using a pretested questioner. Univariate, bivariate and multivariate analysis was done using SPSS version 16.ResultsThe mean age of the respondents was 28.7 (SD 9.9). Majority were 339 (96.9%) males. Significant number of the study subjects 233 (66.6%) had risky driving behaviors. More than a quarter 100 (28.6%) had less knowledge about basic traffic signs. Majority of drivers 181 (51.7%) had negative attitude towards risky driving behaviors. Significant percent of them 148 (42.3%) had a habit of using mobile phone while driving vehicle and 28 (9.7%) had experience of driving after drinking alcohol. All the Bajaj, 97(62.6%) house car and 58(37.4%) taxi unfasten their seat belt while driving. Majority 303 (86.6%) followed the recommended speed limit of driving. About 66 (18.9%) of them had experience of punishment or warning by traffic polices in the previous 1 year and 77 (22%) ever had car accident while driving.ConclusionsDrivers of secondary education and with high average monthly income were more likely to have risky driving behavior. Having supportive attitude towards risky driving behaviors and not getting advice about risky driving from significant others increases the likelihood of developing risky driving behavior. Interventions targeted at developing negative attitude towards risky driving behaviors on drivers and significant others should be implemented to bring positive behavior change. The interventions need to be segmented with educational status and income.

BackgroundEthiopia bears a high burden of visceral leishmaniasis (VL). Early access to VL diagnosis and care improves clinical prognosis and reduces transmission from infected humans; however, significant obstacles exist. The approximate 250,000 seasonal mobile workers (MW) employed annually in northwestern Ethiopia may be particularly disadvantaged and at risk of VL acquisition and death. Our study aimed to assess barriers, and recommend interventions to increase access, to VL diagnosis and care among MWs.Methodology/Principal findingsIn 2017, 50 interviews and 11 focus group discussions were conducted with MWs, mobile residents, VL patients and caretakers, community leaders and healthcare workers in Kafta Humera District, Tigray. Participants reported high vulnerability to VL among MWs and residents engaged in transitory work. Multiple visits to health facilities were consistently needed to access VL diagnosis. Inadequate healthcare worker training, diagnostic test kit unavailability at the primary healthcare level, lack of VL awareness, insufficient finances for care-seeking and prioritization of income-generating activities were significant barriers to diagnosis and care. Social (decision-making and financial) support strongly and positively influenced care-seeking; workers unable to receive salary advances, compensation for partial work, or peer assistance for contract completion were particularly disadvantaged. Participants recommended the government/stakeholders intervene to ensure: MWs access to bed-nets, food, shelter, water, and healthcare at farms or sick leave; decentralization of diagnostic tests to primary healthcare facilities; surplus medications/staff during the peak season; improved referral/feedback/reporting/training within the health system; free comprehensive healthcare for all VL-related services; and community health education.Conclusions/SignificanceContrary to what health policy for VL dictates in this endemic setting, study participants reported very poor access to diagnosis and, consequently, significantly delayed access to treatment. Interventions tailored to the socio-economic and health needs of MWs (and other persons suffering from VL) are urgently needed to reduce health disparities and the VL burden.

Background: In Ethiopia, there are an estimated 25.3 road traffic related deaths per 100,000 population, which is much higher than the global average road traffic fatality rate. Speed is the most well-known risk factor influencing both the risk as well as the severity of the resulting injuries. Although there is paucity of data from low-income countries, speed reducers have been widely approved as an effective traffic calming countermeasure in high-income countries. We aimed to (i) explore the effectiveness of transverse vertical speed reducers and, (ii) qualitatively explore stakeholders’ perceptions of the factors that affect the risk of road traffic crashes.Methods: Data on all crashes occurring from September 2010 to August 2015 were obtained. Interrupted time series analysis using Poisson regression was used to estimate the effect of speed reducers on the number of crashes per month before and after their installation in January 2012. Focus group discussions and in-depth interviews were conducted with traffic police, drivers, drivers’ training center owners, and community members to describe their perceptions about the effects of the speed reducers. Quantitative and qualitative results were triangulated.Results: There were 130 crashes during the study period. Of these, 45.4% were property damage only, and 16.9% were fatal. After the speed reducers were installed, there was no statistically significant difference (incidence rate ratio, IRR =1.17, 95% CI[0.60-2.30], p-value =0.644) in the number of crashes per month, but there were changes in the distribution of crash severity (p-value <0.001). Four core themes, with subsequent sub-themes, emerged as perceived contributors to road traffic crashes. Of these core-themes, speedy and reckless driving, were perceived as the strongest force perpetuating road collisions. Qualitative respondents disagreed on whether the speed reducers were effective and expressed concerns such as the lack of signage to warn drivers.Conclusions: Although speed reducers are proven to reduce collisions in high-income settings, this study in Ethiopia was inconclusive. Inappropriate design for the roadway type, sporadic placement, lack of signage and maintenance, and poor stakeholder coordination may have hampered effectiveness. An evidence-based planning process prior to implementing road design interventions is recommended to achieve the desired results.