Availability of population-level data sources for tracking the incidence of deaths and injuries from road traffic crashes in low-income and middle-income countries

Mitra, Sophie; Neki, Kazuyuki; Mbugua, Leah Watetu; Gutierrez, H; Bakdash, Leen; Winer, Mercer; Balasubramaniyan, Ramshankar; Roberts, Jaeda; Vos, Theo; Hamilton, Erin B; Naghavi, Mohsen; Harrison, James Edward; Job, R. F. Soames; Bhalla, Kavi

doi:10.1136/bmjgh-2021-007296

Cited by 10 publications

(18 citation statements)

References 15 publications

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“…For example, while WHO’s models are calibrated only on countries with high-quality national vital registration data, GBD uses many more sources, including health surveys, verbal autopsies and data representative at the subnational level. Such differences often result in fairly large discrepancies between country-level estimates in many LMICs 6. In fact, as our results for Cambodia show (figure 1), changes in the modelling strategies between the various revisions of GBD alone result in large changes in estimates.…”

Section: Discussionmentioning

confidence: 66%

“…often result in fairly large discrepancies between country-level estimates in many LMICs. 6 In fact, as our results for Cambodia show (figure 1), changes in the modelling strategies between the various revisions of GBD alone result in large changes in estimates.…”

Section: Original Researchmentioning

confidence: 65%

“…5 Our recent review of population-representative data sources in LMICs found that it is increasingly common for national health surveys and censuses to include questions on the incidence of traffic deaths and non-fatal injuries, the prevalence of disability from such injuries and household ownership of different types of vehicles. 6 These data sources are rarely included in WHO and IHME's statistical models providing an opportunity for external validation of these models. Furthermore, local epidemiological data that have been collected by local agencies are often viewed as more legitimate by national stakeholders.…”

Section: Introductionmentioning

confidence: 99%

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Comparing estimates of road traffic deaths and non-fatal road traffic injuries in Cambodia

et al. 2022

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IntroductionTimely, accurate and detailed information about traffic injuries are essential for managing national road safety programmes. However, there is considerable under-reporting in official statistics of many low and middle-income countries (LMICs) and large discrepancies between estimates from the Global Burden of Disease (GBD) study and WHO’s Global Health Estimates (GHE). We compared all sources of epidemiological information on traffic injuries in Cambodia to guide efforts to improve traffic injury statistics.MethodsWe estimated the incidence of traffic deaths and injuries and household ownership of motor vehicles in Cambodia from nationally representative surveys and censuses. We compared findings with GDB and GHE estimates.ResultsWe identified seven sources for estimating traffic deaths and three for non-fatal injuries that are not included as data sources in GBD and GHE models. These sources and models suggest a fairly consistent estimate of approximately 3100 deaths annually, about 50% higher than official statistics, likely because most hospital deaths are not recorded. Surveys strongly suggest that the vehicle fleet is dominated by motorcycles, which is not consistent with GBD estimates that suggest similar numbers of motorcyclist and vehicle occupant deaths. Estimates of non-fatal injuries from health surveys were about 7.5 times official statistics and 1.5 times GBD estimates.ConclusionIncluding local epidemiological data sources from LMICs can help reduce uncertainty in estimates from global statistical models and build trust in estimates among local stakeholders. Such analysis should be used as a benchmark to assess and strengthen the completeness of reporting of the national surveillance system.

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Section: Discussionmentioning

confidence: 66%

Section: Original Researchmentioning

confidence: 65%

Section: Introductionmentioning

confidence: 99%

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Comparing estimates of road traffic deaths and non-fatal road traffic injuries in Cambodia

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“…Future research should collect information on the source of RTI (motorized vehicle occupant, non-motorized vehicle occupant or pedestrian) as well as assess the severity of the RTI, along with spatial and temporal patterns. Broadly, research in this area should prioritize improved coordination and use of systematic traffic injury measurements in order to strengthen surveillance and contribute effectively to RTI mitigation globally [33].…”

Section: Future Research and Policy Implicationsmentioning

confidence: 99%

The neglected epidemic—Risk factors associated with road traffic injuries in Mozambique: Results of the 2016 INCOMAS study

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Sorensen

et al. 2022

PLOS Glob Public Health

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In 2019, 93% of road traffic injury related mortality occurred in low- and middle-income countries, an estimated burden of 1.3 million deaths. This problem is growing; by 2030 road traffic injury will the seventh leading cause of death globally. This study both explores factors associated with RTIs in the central region of Mozambique, as well as pinpoints geographical “hotspots” of RTI incidence. A cross-sectional, population-level survey was carried out in two provinces (Sofala and Manica) of central Mozambique where, in addition to other variables, the number of road traffic injuries sustained by the household within the previous six months, was collected. Urbanicity, household ownership of a car or motorcycle, and socio-economic strata index were included in the analysis. We calculated the prevalence rate ratios using a generalized linear regression with a Poisson distribution, as well as the spatial prevalence rate ratio using an Integrated Nested Laplace Approximation. The survey included 3,038 households, with a mean of 6.29 (SD 0.06) individuals per household. The road traffic injury rate was 6.1% [95%CI 7.1%, 5.3%]. Urban residence was associated with a 47% decrease in rate of injury. Household motorbike ownership was associated with a 92% increase in the reported rate of road traffic injury. Higher socio-economic status households were associated with a 26% increase in the rate of road traffic injury. The rural and peri-urban areas near the “Beira corridor” (national road N6) have higher rates of road traffic injuries. In Mozambique, living in the rural areas near the “Beira corridor”, higher household socio-economic strata, and motorbike ownership are risk factors for road traffic injury.

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“…Despite extensive global advocacy, the first UN Decade of Action on Road Safety ended in 2020 without a marked increase in evidence-based road safety programmes in most low-income and middle-income countries (LMICs), especially in the sub-Saharan African region 1 2. One important reason for the low priority of traffic injuries in the national policy agenda of LMICs is that the scale of the problem is underestimated by country governments 3. Therefore, in recent years, researchers and international agencies have sought to highlight under-reporting in official statistics of the incidence of road traffic injuries 3–5.…”

Section: Introductionmentioning

confidence: 99%

Estimates of road traffic deaths in Tanzania

et al. 2022

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IntroductionThere is considerable uncertainty in estimates of traffic deaths in many sub-Saharan African countries, with the Global Burden of Disease (GBD) and the Global Status Report on Road Safety (GSRRS) reporting widely differing estimates. As a case study, we reviewed and compared estimates for Tanzania.MethodsWe estimated the incidence of traffic deaths and vehicle ownership in Tanzania from nationally representative surveys. We compared findings with GBD and GSRRS estimates.ResultsTraffic death estimates based on the 2012 census (9382 deaths; 95% CI: 7565 to 11 199) and the 2011–2014 Sample Vital Registration with Verbal Autopsy (8778; 95% CI: 7631 to 9925) were consistent with each other and were about halfway between GBD (5 608; 95% UI: 4506 to 7014) and WHO (16 252; 95% CI: 13 130 to 19 374) estimates and more than twice official statistics (3885 deaths in 2013). Surveys and vehicle registrations data show that motorcycles have increased rapidly since 2007 and now comprise 66% of vehicles. However, these trends are not reflected in GBD estimates of motorcycles in the country, likely resulting in an underestimation of motorcyclist deaths.ConclusionReducing discrepancies between GBD and GSRRS estimates and demonstrating consistency with local epidemiological data will increase the legitimacy of such estimates among national stakeholders. GBD, which is the only project that models the road-user distribution of traffic deaths in all countries, likely severely underestimates motorcycle deaths in countries where there has been a recent increase in motorcycles. Addressing police under-reporting and strengthening surveillance capacity in Tanzania will allow a better understanding of the road safety problem and better targeting of interventions.

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Availability of population-level data sources for tracking the incidence of deaths and injuries from road traffic crashes in low-income and middle-income countries

Cited by 10 publications

References 15 publications

Comparing estimates of road traffic deaths and non-fatal road traffic injuries in Cambodia

Comparing estimates of road traffic deaths and non-fatal road traffic injuries in Cambodia

The neglected epidemic—Risk factors associated with road traffic injuries in Mozambique: Results of the 2016 INCOMAS study

Estimates of road traffic deaths in Tanzania

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