Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries

Abstract

BackgroundRoad traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world’s road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap.MethodsIn accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes.ResultsOf the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention.ConclusionLegislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the impact of improvements will affect speed and traffic flow. Further road traffic injury prevention interventions should be performed in LMICs with patient-centered outcomes in order to guide injury prevention in these complex settings.

Cost-effectiveness of interventions to prevent road traffic injuries in low- and middle-income countries: A literature review

“…This study supports the finding that there continues to be a paucity of comprehensive costeffectiveness evidence to support the adoption and implementation of interventions in LMIC settings that have been shown to prevent injuries due to road traffic (Staton et al 2016;Wesson et al 2014). We have illustrated the need for further studies that explore outcomes specifically for children, young people and vulnerable road users.…”

Expected years of life lost through road traffic injuries in Mexico

“…They result from the interaction of road users, vehicles, and infrastructure [26]. The published data regarding interventions to reduce the related burden in low- and middle-income countries is limited [27]. The World Report on RTI prevention highlights the need for an integrated effort focusing on improved information systems, response capacity strengthening, and reduced exposure to modifiable risk factors plus the availability of resources for targeting them [17].…”

“…Most of the cost-effectiveness strategies to reduce the RTI burden in low- and middle-income countries are linked to legislative interventions [27]. The current Mexican road legislation is permissive and poorly applied [31].…”

Regional disparities in road traffic injuries and their determinants in Brazil, 2013

“…Furthermore, particularly for low an middle-income countries, the most effective measures combine legislation and enforcement initiatives focused on main risk factors, especially excessive speed and alcohol use [41]. …”