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Johns Hopkins International Injury Research Unit

A World Health Organization Center for Injuries, Violence and Accident Prevention

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Keyword: road traffic injury

The results of a recent study led by Johns Hopkins International Injury Research Unit (JH-IIRU) team members suggests that a multi-faceted road safety intervention program is potentially effective in reducing road traffic crashes in a middle-income country setting.

In January 2008, the World Health Organization (WHO) and the Mexican Ministry of Health and the National Center for Accident Prevention (CENAPRA) launched a national multi-faceted road safety intervention program called the Iniciativa Mexicana de Seguridad Vial y Prevención de Lesiones en el Tránsito (Mexican Initiative for Road Safety and Prevention of Road Traffic Injuries) (IMESEVI), funded by the Bloomberg Philanthropies.  The IMESEVI approach utilized a package of evidence-based polices into a comprehensive multipronged effort to reduce the burden of road traffic injuries and deaths in four Mexican cities, including Guadalajara (Jalisco) and León (Guanajuato). The interventions focused on augmenting drink-driving enforcement and seatbelt and child restraint use campaigns.

Two years after the initial launch of IMESEVI, Bloomberg Philanthropies funded the Global Road Safety Program to improve road safety in 10 low- and middle-income countries—including Mexico—which subsequently began the second phase of IMESEVI. In this phase, both Guadalajara and León were included, but the interventions focused on drink-driving enforcement and legislation in the first year, with the addition of seatbelt and child restraint campaigns in the second year.

The study, conducted by JH-IIRU team members in collaboration with local collaborators at the Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, in Cuernavaca, México, used a time series analysis to assess the effectiveness of both phases of the IMESEVI on Mexico’s road traffic crashes, injuries and deaths.

While the study had several limitations, including the lack of information regarding alcohol consumption at a national level and the quality of secondary information available in Mexico, results suggest that such a multi-faceted intervention program appears to be effective in reducing road traffic crashes.

Access “Early Impact of a National Multi-Faceted Road Safety Intervention Program in Mexico: Results of a Time-Series Analysis,” published in PLOS One, here.

This is the time of year when many people travel, both near and far, in order to celebrate the holidays with friends and family. The season can be a great time for get-togethers, but it can also be especially dangerous for travelers.

Many of us know someone affected by the tragedy of a road traffic crash. It’s a global epidemic that claims two lives every minute on the world’s roads. That adds up to a staggering 1.3 million people every year. How can you stay safe? Here are a few tips:

1.Always use your seatbelt.

2.Do not mix alcohol or other drugs with driving.

3.Avoid distractions by turning off your mobile device; keep your eyes on the road and your hands on the wheel.

4.Make sure you are well rested and adhere to the speed limit.

5.Keep your vehicle safe with regular car and tire maintenance.

6.If you are a parent of an infant or young child, learn about the proper child restraints by visiting http://www.aap.org/healthtopics/carseatsafety.cfm; if you are the parent of a teenager, visit the CDC’s Parents Are the Key to Safe Teen Drivers campaign at http://www.cdc.gov/ParentsAreTheKey/index.html

While the majority of road traffic fatalities occur in the developing world, road traffic injuries are the top killer of healthy Americans traveling abroad, so these rules don’t change, no matter where you spend your holiday.

For additional information, the Journal of Travel Medicine recently published, “Pre-travel consultation without injury prevention is incomplete,” written by JH-IIRU project coordinator, Shirin Wadhwaniya and director, Adnan Hyder.  Injury Prevention recently published “Rates of intentionally caused and road crash deaths of US citizens abroad,” with contributions by JH-IIRU senior technical advisor, David Bishai and Adnan Hyder.

Access the Journal of Travel Medicine here.

Access Injury Prevention here.

In an effort to reduce the burgeoning burden of road traffic injuries and fatalities, governments, non-governmental organizations (NGOs), and researchers like the JH-IIRU team work to implement interventions that will reduce the number of road-related deaths and injuries. Such efforts, however, are often tied to budget constraints. Performing cost-benefit analyses can be a useful tool for priority-setting for road safety interventions.

Recently, JH-IIRU team member, research assistant, Andres Vecino-Ortiz, published “The Use of Cost-Benefit Analysis in Road Assessments: A Methodological Inquiry,” in Injury Prevention. The paper evaluates the rapid assessment metric to estimate the value of statistical life (VOSL) developed by the International Road Assessment Program (iRAP). VOSL is a metric used to estimate the benefits of road safety interventions in cost-benefit analysis.

The iRAP tool can be used to estimate the return of road safety interventions in low- and middle-income countries (LMICs), as it aims to calculate the costs of death and serious injuries that would be prevented by road infrastructure improvements. The paper found that the metric has some challenges that should be taken into consideration in VOSL estimations; the paper recommended that the tool disclose assumptions, use sensitivity analysis and avoid omitted variables bias.

To read more, access the paper here: http://www.ncbi.nlm.nih.gov/pubmed/23710063

According to the World Health Organization, 90% of all injury-related deaths occur in low- and middle-income countries, but often health care facilities in developing nations are unable to provide much-needed emergency services. And while injury -- in particular road traffic injury (RTI) -- has received increasing attention, strategies to strengthen trauma care have often been lacking.

 As part of the Road Safety in Ten Countries (RS-10) project, the Johns Hopkins International Injury Research Unit (JH-IIRU) has been tasked with implementing, monitoring, and evaluating trauma care in Kenya, because, while we recognize that injury prevention is the primary overall objective of the RS-10 project, even with the best interventions, injuries will continue to occur.

To that end, in an effort to build collaboration and consensus among the many organizations and individuals who provide initial care for the injured patient, Dr. Kent Stevens, JH-IIRU Associate Director for Trauma Systems and Clinical Services, co-led an Emergency Medical Systems (EMS) symposium in one of the two RS-10 intervention sites in Kenya.

“Connecting the Dots: A Unified EMS System in Kenya” was held from August 7-8, in Naivasha. Jointly sponsored by JH-IIRU and the CDC Kenya, the conference was attended by key stakeholders involved in pre-hospital and hospital care in Kenya. The attendees included emergency medical technicians as well as representatives from the Kenyan Ministry of Medical Services, the Ministry of Public Health and Sanitation as well as Kenyatta National Hospital and non-governmental organizations and academics.

The symposium aimed to cover all aspects of trauma care in Kenya, from preparedness to response, with an emphasis on how policy can be implemented and ways to engage decision makers in the country.

Dr, Stevens characterized the conference as a resounding success, “The discussions were lively and helpful, with wide participation and a solid plan of action put in place.”

Through improvement of pre-hospital and hospital care and understanding the experience of the injured patient in Kenya, JH-IIRU to will continue our commitment to saving lives, both in the short-term and for years to come.

EMS Kenya
Participants of "Connecting the Dots: A Unified EMS System in Kenya"

The World Health Organization estimates that road traffic injuries (RTIs) account for approximately 1.2 million deaths annually around the globe, with the majority occurring in low- and middle-income countries. In countries like Cambodia, motorcycles are a common form of transportation, and their popularity is predicted to increase.

Head injuries are a main cause of disability and death in motorcycle crashes, but helmet use in Cambodia remains relatively low, despite the fact that helmet-wearing is a proven injury prevention intervention .
 
In order to assist with better planning and implementation of injury prevention strategies, JH-IIRU team members, including Associate Director Abdulgafoor M. Bachani, along with colleagues from Handicap International, Belgium and the Centers for Disease Control and Prevention published, “Helmet Use Among Motorcyclists in Cambodia: A Survey of Use, Knowledge, Attitudes and Practices.” The goal of the study was to assess the current status of helmet use in five districts in Cambodia as well as knowledge, attitudes and practices related to helmet use. 

As part of the Road Safety in 10 Countries project (RS-10), in 2012, JH-IIRU published “Public Health Burden of Road Traffic Injuries: An Assessment from Ten Low- and Middle-Income Countries,” a special issue of Traffic Injury Prevention. This landmark publication includes 11 scientific papers jointly authored with 50 colleagues from JH-IIRU and their in-country collaborators that contribute much-needed new knowledge to the burgeoning issue of road traffic injuries in low- and middle- income countries.

You can access the full article along with the entire special issue here.

To find out more about JH-IIRU and road safety, contact us at
IIRU@JHSPH.edu

World Health Organization

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