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Johns Hopkins International Injury Research Unit

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

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Keyword: cambodia

Each year – according to the Global Status Report on Road Safety 2018 – 1.3 million people die on the world’s roads. Another 20-50 million sustain non-fatal injuries, and among 15-29 year-olds road traffic injuries (RTIs) are the leading cause of death globally.

Statistics such as these fuel our work here at the Johns Hopkins International Injury Research Unit to work tirelessly within the road safety field and strive to reduce the burden of RTIs around the world.

As we conclude another phase working with Bloomberg Philanthropies and international partners, we can reflect on our time working across 10 cities and 10 countries to reduce non-fatal and fatal RTIs and impact key risk factors.

  1. Understand your data sources
    When our team was in Vietnam, studying mortality due to RTIs, we had a number of secondary data sources at our disposal and each provided us with different information. From police and hospital data, to national surveys and commune level vital registration information, we were able to draw diverse insights on everything from injury and fatality rates to crash frequencies and details.

    Such is the case for road safety data around the world: to ensure the full story, it’s important to gather from multiple sources and understand the value that each has.
  2. Repeated measurements are useful in monitoring trends and identifying focus areas
    As we learned when we studied helmet use, speeding, restraint use, and drink driving in these cities and countries, repeated rounds of measurement are important to identify patterns and trends; they can help with identification of emerging issues as well as highlight areas of programmatic success.

    If we hadn’t looked at multiple rounds in Bangkok, for example, we wouldn’t have as clearly been able to conclude that females had a significantly lower rate of helmet use, or to focus on passengers, weekends, and evening/night-time enforcement.
  3. Mixed methods approach necessary to understand underlying factors
    To truly paint accurate road safety pictures, we utilized a combination of both quantitative and qualitative studies. And in doing so, this mixed-methods approach provided a clearer understanding of factors underlying the observed trends or outcomes than if we implemented a more one-dimensional focus.

    While conducting KAP roadside interviews in two Kenyan towns, we analyzed nearly 5,000 respondents’ answers to questions on the top factors related to the decision to speed, as well as the proportion that knew the speed limit at the part of the road. These analyses were helpful in assessing each towns’ road safety climate. Complementing them, however, were the insightful interviews that provided a more detailed commentary on the situation.
  4. Coordinated efforts necessary for sustained improvement
    It takes a village to oversee continued progress, which we learned throughout our work, including during drink-driving observations in Addis Ababa.

    Assessing the drink-driving rate in the Ethiopian city over more than three years, for example, we could cross-reference critical points of partner efforts such as mass media campaigns and enforcement. In doing so, we learned the significant impact of each strategy and, in tandem with each other, the overall value provided to the community.
  5. External activities do have an impact
    Sometimes, independent and uncontrollable events and activities can become mechanisms for change, too.

    During our time in Cambodia, for example, we tracked helmet wearing rates among drivers and pinpointed several newsworthy dates that triggered an impact. From the floods in Kandal and Kampong Speu, to the national elections, and even the funeral of a former king, the scope and visibility of enforcement in the region became catalysts for behavior change, both positive and negative.
  6. You can’t do it alone!
    Through the collaboration with multidisciplinary partners, messages can be amplified and the reach can be widened.

    Studying information sharing across stakeholders in Colombia, we were able to glean the true potential of campaigns when working in larger networks and increasing capacity development. As we mapped, our network of report sharing between local stakeholders, such as Universidad de Los Andes and Universidad de Antioquia, as well as other organizations including iRAP, World Bank, Vital Strategies, and World Resource Institute, we saw a greater impact and effect on our stakeholders, ranging from the media and general public, to the Bogota Traffic Police and other city government agencies.

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. Motorcycle crashes are also the leading source of road traffic fatalities in the country.. However, helmet use in Cambodia remains relatively low, despite the fact that helmet-wearing is a proven injury prevention intervention.

In order to better understand the traffic safety culture in Cambodia, a group of researchers, including JH-IIRU associate director, Abdulgafoor Bachani, recently examined driver and passenger knowledge, attitude and beliefs regarding motorcycle helmets.

Several key findings from the study helped identify barriers to helmet-wearing, including gaps in road safety knowledge and ways to communicate the road safety message more effectively. For example, the study found that there is a need to increase the availability of high-quality, low cost helmets for children, while at the same time addressing the prevailing attitude that children are “too young” to need a helmet. The study also found that many motorcyclists believe helmets are only necessary when driving on highways or high speed motorways.

Results of this study were instrumental in informing the Cambodian Helmet Vaccine Initiative (CHVI) which was established by the Asia Injury Prevention Foundation with support from the FIA Foundation as well as the World Bank, the US Centers for Disease Control and Prevention and others.

“Motorcycle Helmet Attitudes, Behaviours and Beliefs Among Cambodians” appears in the International Journal of Injury Control and Safety Promotion.

To read more, click here:

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

As part of the Road Safety in 10 Countries project (RS-10), the Johns Hopkins International Injury Research Unit (JH-IIRU) has been tasked with training and capacity development of local personnel in each of the ten countries. To that end, members of the JH-IIRU team, including associate directors Abdulgafoor M. Bachani, PhD, MHS and Aruna Chandran, MD, MPH, will host the “National Workshop on Evaluation Methods for Road Safety” in Phnom Penh, Cambodia.  This workshop, held from March 21-23, 2012, will provide an overview of monitoring and evaluation for national road safety programs, including evaluation designs for road safety and data collection options.  The workshop will be attended by Drs. Pham V Cuong and La Ngoc Quang, faculty from the Hanoi School of Public Health and Dr. Ricardo Pérez Núñez from the National Institute of Public Health, Mexico (Instituto Nacional de Salud Pública). Additionally, representatives from the National and Provincial Road Safety Committees in Cambodia, local NGOs, researchers, and others will be in attendance.

These skill- and knowledge-based on-site workshops for in-country collaborators, partners and researchers are part of the three-pronged capacity development strategy, which also includes training  and  mentoring  during  the  course  of  monitoring  and  evaluation (M&E) work in each of the countries (learning by doing); and development and offering of courses on public health methods for road safety.

Several targeted workshops have been conducted in each of the ten countries and have been tailored to meet local needs. In the first two years of the RS-10 project, more than 250 individuals across the 10 countries have been trained through these workshops.      
For more information on the Road Safety in 10 Countries project, which is funded with support from Bloomberg Philanthropies, contact us at, or visit our website: 

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