Interventions to reduce pedestrian road traffic injuries: A systematic review of randomized controlled trials, cluster randomized controlled trials, interrupted time-series, and controlled before-after studies

Abstract

Background Road traffic injuries are among the top ten causes of death globally, with the highest burden in low and middle-income countries, where over a third of deaths occur among pedestrians and cyclists. Several interventions to mitigate the burden among pedestrians have been widely implemented, however, the effectiveness has not been systematically examined. Objectives To assess the effectiveness of interventions to reduce road traffic crashes, injuries, hospitalizations and deaths among pedestrians. Methods We considered studies that evaluated interventions to reduce road traffic crashes, injuries, hospitalizations and/or deaths among pedestrians. We considered randomized controlled trials, interrupted time-series studies, and controlled before-after studies. We searched MEDLINE, EMBASE, Web of Science, WHO Global Health Index, Health Evidence, Transport Research International Documentation and ClinicalTrials.gov through 31 August 2020, and the reference lists of all included studies. Two reviewers independently screened titles and abstracts and full texts, extracted data and assessed the risk of bias. We summarized findings narratively with text and tables. Results A total of 69123 unique records were identified through the searches, with 26 of these meeting our eligibility criteria. All except two of these were conducted in high-income countries and most were from urban settings. The majority of studies observed either a clear effect favoring the intervention or an unclear effect potentially favoring the intervention and these included: changes to the road environment (19/27); changes to legislation and enforcement (12/12); and road user behavior/education combined with either changes to the road environment (3/3) or with legislation and enforcement (1/1). A small number of studies observed either a null effect or an effect favoring the control. Conclusions Although the highest burden of road traffic injuries exists in LMICs, very few studies have examined the effectiveness of available interventions in these settings. Studies indicate that road environment, legislation and enforcement interventions alone produce positive effects on pedestrian safety. In combination with or with road user behavior/education interventions they are particularly effective in improving pedestrian safety.

A methodology for the public health surveillance and epidemiologic analysis of outdoor falls that require an emergency medical services response

“…Placing this in context, in 2019 this figure is 70% higher than estimates of the number of pedestrians (76,000) injured by automobiles in 2019 (National Highway Traffic Safety Administration 2021 ). While there is a large body of research on pedestrian injuries from automobiles (Halari et al 2020 ; Namatovu et al 2022 ; Rezapur-Shahkolai et al 2022 ; Wilmut et al 2022 ), there is almost no literature on pedestrian injuries from falls that occur on streets and sidewalks (Timsina et al 2017 ). This discrepancy in research attention translates into a marked focus on policy and design interventions to prevent pedestrian injuries from automobiles, including the national Vison Zero program, and minimal focus on interventions to prevent pedestrian injuries from outdoor falls, even though these injuries occur in the same or adjacent physical environments (Evenson et al 2018 ).…”

Interventions to improve pedestrian and cyclist safety in Latin America: a systematic review and metasummary

“…Huicho et al's (2012) This study demonstrates the limited body of peerreviewed work on this public health issue in Latin America, mirroring a global issue. Although the majority of VRU deaths globally occur in LMICs, very few interventions to address this issue have been evaluated in these settings (Namatovu, 2022). It is important to highlight that some known initiatives were not included in the review due to the lack of academic evaluation and/or failure to meet inclusion criteria, specifically studies that communicate VRU safety outcomes following the implementation of an intervention.…”

Investigating and Improving Pedestrian Safety in an Urban Environment of a LMIC: A Case Study of Yaoundé, Cameroon

“…The strategy covers seven years (2024 -2030) with the goal of improving the PSI and WKI along all the street to a grade B minimum and along street with 75% of the pedestrian flow to a grade A. The strategy is not only limited to engineering action (pedestrian facilities improvement) but also include legislation/enforcement, policy and land use, training and education, awareness campaign, which have been found effective in improving pedestrian safety [29], [41]- [46], [115]. The strategy draws from the experience of similar strategies developed for Austin, Texas, and Connecticut in the USA [115][116][117].…”

“…Several engineering interventions to improve pedestrian safety have been proven effective when properly implemented. These include road lighting [41], road narrowing with refuge island [29], raised pedestrian crossing [29,42], reducing speed with 30km/h posted speed limit [43] and traffic calming measures (speed hump, speed table, speed cushion, tight corner radii, etc..) [44][45][46]. Investing in road safety and in pedestrian facilities does not only yield safety benefits, but also health, economic and environmental benefits as a result of increased active mobility.…”