Promoting traffic safety in low- and middle-income countries

This issue of the journal features several articles from many parts of the world including high-income countries (HICs) and low- and middle-income countries (LMICs). The articles span from traffic safety to sports injury identification and from child injury prevention to drowning prevention via pool fencing legislation and efforts to reduce alcohol consumption in emergency department patients. There are two thought-provoking pieces on children from New Zealand. One of them focuses on injuries and deaths in the 0–4 year-old group, the majority of which occur at home. The other piece attempts an examination of legislation and fencing of swimming pools to prevent death by drowning in young children. By any measureable statistic, injuries and deaths to children is an area that needs to be researched and studied much more and, therefore, the journal aims to redress the balance and effect compensation in future issues.

An extended article from Australia makes a pioneering effort to extract viable data from an uncommon source for analysis. It explores the narratives of triage nurses in emergency departments in an attempt to identify and isolate sports injury cases from others. The paper on alcohol consumption in emergency department patients is a pioneering work on the subject done in Europe for the first time. It represents a path-breaking investigation into alcohol intake and motivation to reduce drinking among injured and non-injured patients in hospitals in Sweden.

Additionally, this journal issue features four articles from some LMICs – Iran, Jamaica, and Nigeria – reminding us all to tighten our efforts on traffic safety promotion in LMICs. Is it surprising that all four articles from these LMICs focus on traffic safety? No, it should not be at all surprising given the fact that traffic injuries are among the second to the eighth leading causes of death among people ages 5–69 years globally and that people in LMICs bear the brunt of this loss (Global Status Report on Road Safety, 2009). In fact, a thorough search of the tables of contents of the major journals devoted to injury control reveals the prominence attached to the subject of traffic safety. For example, every issue of this journal during the past 3 years has featured at least one article on traffic safety. The same can be said of its sister journal, Injury Prevention, where there has been at least three articles published on traffic safety in each issue during the past two years.

Globally, more than 1.2 million people are killed in road traffic crashes annually and about 50 million more are injured or disabled. Current estimates from the World Health Organization indicate that these road traffic injuries account for about 2.2% of the global deaths and represent close to 3.0% of the disability-adjusted life years lost from all causes. The most disturbing part is that LMICs account for about 90% of these deaths and disability-adjusted life years lost annually. Pathetically, nearly half of those dying on the world's roads are vulnerable road users, including child pedestrians, bicyclists, and motorcyclists. The economic cost of road traffic crashes is very staggering, topping the US$ 518 billion mark (Global Status Report on Road Safety, 2009).

The first article on Iran highlights the socio-demographic and death circumstances of victims of fatal road traffic injuries in one province in Iran, a country with one of the highest mortality rates from road traffic crashes. The finding that only 11% of road traffic victims receive ambulance transport, unlike in a HIC, is rather sad, particularly when two-thirds of deaths occurred prior to arrival at the hospital. This is similar to what was reported in a Ghanaian study a decade ago (Forjuoh, Mock, Friedman, & Quansah, 2009). The authors correctly advocate for countermeasures to save innocent lives in the region. In the second article, the authors use a road profiling approach to assess the magnitude of traffic related injuries in one city in Nigeria. A minor segment of roadways was found to account for at least 84% of all traffic crashes, injuries, and fatalities. Here again, the authors appeal for countermeasures on roadways and intersections with the propensity for most crashes.

The third article focuses on motorcycle injuries in Jamaica. Using hospital records, the authors estimated motorcycle helmet use rate at slightly fewer than 50%. The final article, from Iran, describes traffic crashes over an 11-year span in the country. Over the 11-year study period, the rate of road traffic injuries per 100,000 population increased a whopping 265% from 109.7 in 1997 to 400.6 in 2005 before decreasing to 343.1 in 2007. The authors attributed the modest but statistically significant 14% decreased rate between 2005 and 2007 to improved safety of modern vehicles, avoidance of high-risk driving behaviors, wearing of helmets and seatbelts, and the increased congestion in the cities, which are all plausible reasons. The authors, therefore, conclude that their investigation shows that a decrease in fatal road traffic injuries is achievable in a developing country.

Not surprisingly, the common thread on all four articles is the need for policy response and action to prevent this carnage on our roads. Indeed, the need for intense policy response and appropriate, timely action towards effective traffic safety in LMICs is more pressing now than at any time. First, the capacity building on researchers to unravel the unusual circumstances of the road traffic problem in LMICs is on the ascendancy. Second, several international organizations like the WHO, the World Bank, the UNICEF, and the United Nations have also begun to assist with these efforts. Adding to this is the proliferation of many governmental and non-governmental organizations working in the traffic safety arena in many of these LMICs. Finally, the availability of several proven HIC interventions for translation to LMICs is the needed catalyst to this process, with the caveat to consider costs, contexts, and cultures in the translation process (Forjuoh, 2003; Mohan, 2008; Naci, Chisholm, & Baker, 2009). For example, a recent study in China demonstrated that it is possible to replicate the methods used in HICs to increase the prevalence of seat-belt use in LMICs (Stevenson et al., 2008).

We all have an ethical responsibility to do our part in addressing the traffic injury problem in LMICs (Mohan 2008). The cost of inaction will be enormous for posterity and affects all of us individually and collectively, whether we live in a HIC or a LMIC. With a rapidly aging population worldwide, HICs will even soon need to re-visit their road safety strategies to address their emerging vulnerabilities. Road traffic safety strategies that focus on motorists, pedestrians, bicyclists, and motorcyclists as well as on speed control, education against drinking and driving, seat-belt use, child restraint use, legislation enforcement, and environmental changes, among others with our collective actions will result in a big payoff. By so doing, we may prevent someone from being run over by a car with faulty brakes, another from being crashed by a drunk driver, and a loved one from falling off their motorcycle and crashing their head because they were not wearing a helmet. We definitely know so much about preventing road traffic crashes and promoting traffic safety. What is really needed is advocating for positive policy changes and the appropriate, timely actions. This is not asking too much of us at all. Definitely not!

In future issues, we will try our very best to seek and publish new and relevant work wherever they may emanate from. The research work that is presented in this journal is an essential step towards its adoption and application by decision makers. This is the hiatus that has to be spanned, more so in LMICs where mobility and mortality is on the rise for a variety of complex reasons. It will be our constant endeavor to push for zero tolerance in matters of injuries and deaths through the publication of the best and the most current material in the field of injury control and safety promotion.