Rural transport health and safety in sub-Saharan Africa: Online survey snapshot of expert opinion

Figures & data

Table 1. Key points derived from the literature on which survey questions were based.

Research theme	Key points summarised from the literature	Survey question(s)
Different categories of road users experience different levels of risk and exposure to road crashes	According to Nantulya & Reich (2002), some 85% of global deaths from road crashes occurred in developing countries. They noted that the poor, often rural, disproportionately bear this burden and specifically called out the impact among vulnerable road users (i.e. pedestrians and cyclists) and passengers of transport service vehicles (i.e. buses and minibuses). Odero et al. (2003) reported that the majority of fatal crashes in Kenya involved transport service vehicles and that the majority of passengers killed in these were on inter-urban roads in rural areas. Elsewhere in the literature, the increasing reliance on motorcycles throughout rural sub-Saharan Africa was noted as a major safety concern. Motorcycle taxis are becoming an increasingly important means of mobility throughout rural Africa, for example: Uganda (Bryceson et al., 2003), Tanzania (Porter et al., 2013), Nigeria (Olubomehin, 2012) and in general (Kumar, 2011). Madubueze et al. (2011) reported that most (54%) injuries seen in a rural Nigerian hospital were motorcycle related. Similarly, 60% of 395 injury cases at a rural hospital in Cameroon involved motorcycles (Mefire et al., 2013)	4
Different physical road conditions and characteristics of infrastructure affect the occurrence of crashes	Many factors are reported as contributing to road crashes – for example, Lord et al. (2003) cited poor road conditions as a factor in Burkina Faso, and Manyara (2013) noted similar circumstances in Kenya. Over 70% of the road network in sub-Saharan Africa remains unpaved (Greening & O’Neill, 2010). Edvardsson (2009) cited dust on rural roads as a safety hazard because it occludes driver vision, particularly for motorcycles. Mfinanga (2014) noted the importance of roadway signing especially as related to pedestrian safety	5
A range of risky driving behaviours affect road safety	Risky driving behaviours such as speeding, aggressing driving, unskilled diving and overloading vehicles have been shown to contribute to elevated levels of injuries and fatalities on rural roads throughout Africa (e.g. Damsere-Derry et al., 2008; Oluwadiya et al., 2009; Bachoo et al., 2013). Similarly, driving while intoxicated has been reported as a serious problem in sub-Saharan Africa by numerous researchers (e.g. Kobus, 1980; Odero, 1998; Mupimpila, 2008; Ogazi & Edison, 2012)	6
Road crashes impact women and children disproportionally	Some 96% of the children killed globally in road crashes were in developing countries (Nantulya & Reich, 2002). Adesunkanmi et al. (2000) noted that the majority of 324 injured children in a hospital in rural western Nigeria were crash victims. A study of some 23 000 injuries treated in a tertiary Malawian hospital concluded that 10% involved pedestrian victims between the ages of six and 10 years, the majority of which were female (Kiser et al., 2012). Women bear a disproportionate transport burden in rural sub-Saharan Africa. Often women fall into the vulnerable road user category (typically as pedestrians). They are also often responsible for the transport of goods (e.g. agricultural products to market) and find themselves in dangerous situations with goods and passengers. Women are also typically in charge of and directly involved in the transport of children (Bryceson, 1993; Porter, 2002)	7
Dust from transportation sources poses direct health risks associated with pollution exposure and also may reduce visibility for drivers thereby increasing the risk of crashes	Greening & O’Neill (2010) reported that more than 70% of the sub-Saharan Africa road network is unpaved and that in a US study some 40% of fugitive atmospheric dust is attributable to unpaved roads. van Gemert et al. (2011) and Musafiri et al. (2011) have documented the serious health impacts associated with particulate matter (PM) pollution in rural Africa. The risk of wheezing was shown to increase in occupants of homes within 150 m of the road in Jimma, Ethiopia (Venn et al., 2005). Children in Warri, Nigeria were shown to have elevated occurrences of coughing and wheezing attributable to PM emissions (Mustapha et al., 2011). Ekpenyong et al. (2012) specially addressed traffic pollution exposure among taxi drivers and motorcyclists in Uyo, Nigeria. Motorcyclists were most impacted from exposure to the traffic pollution. Recognising the prevalence and, indeed, importance of roadside commerce in sub-Saharan Africa, it is worth noting that Kinney et al. (2011) discussed traffic-emitted PM exposure for street vendors in Nairobi	8 and 9
Increased mobility improves public health	The issues surrounding rural healthcare access are myriad and complex. Enhanced access to medical care directly improves health outcomes (Downing & Sethi, 2001; Porter, 2014). Access to education and economic opportunities indirectly affects health outcomes (Porter, 2002, 2014)	10 to 13

Figure 1. The sub-Saharan Africa countries in which internet survey respondents noted professional experience.

Figure 2. Summary of professional affiliations of respondents. Note: NGO = non-governmental organisation.

Figure 3. Summary of professional specialties of respondents.

Figure 4. Summary of results from Question 4.

Table 2. Overall average weightings for Question 4.

Transport mode
	Transport services	Vulnerable road users	Motorcycles
Average weighting	2.7	2.9	3.5

Figure 5. Summary of results from Question 5.

Table 3. Research needs scoring.

Rating	Interpretation
5	Very important – requires immediate attention
4	Important – should be addressed within the next five years
3	Moderately important – should be included in future research plans
2	Unimportant – warrants continued study as opportunities arise
1	Very unimportant – has already been adequately addressed or is not a major issue

Table 4. Overall average weightings for Question 5.

Road condition
	Dust from unpaved roads	Condition of travelway	Lack of adequate signage
Average weighting	3.5	3.8	3.9

Figure 6. Summary of results from Question 6.

Table 5. Overall average weightings for Question 6.

Driving behaviours
	Distracted driving	Non-use of safety equipment	Driving under the influence	Aggressive driving	Poor driving
Average weighting	3.5	3.9	4.0	4.3	4.3

Figure 7. Summary of results from Question 7.

Figure 8. Summary of results from Question 8.

Table 6. Overall average weightings for Question 8.

Groups at risk of air pollution exposure
	Occupants of roadside residences and businesses	Individuals in roadway environment	Vehicle passengers
Average weighting	3.9	3.7	1.9

Figure 9. Summary of results from Question 9.

Figure 10. Summary of results from Question 10.

Figure 11. Summary of results from Question 11.

Table 7. Overall average weightings for Question 11.

Access to …
	General / preventative	Disease / chronic condition	Paediatric	Emergency / trauma	Maternal / pre-natal care
Average weighting	2.3	2.6	3.1	3.7	4.6

Figure 12. Summary of results from Question 12.

Table 8. Overall average weightings for Question 12.

Enhancing safe education accessibility
	Provision of transport services	Road/travel safety education and awareness for children and parents	Provision of pedestrian facilities
Average weighting	4.2	4.2	4.0

Figure 13. Summary of results from Question 13.

Figure 14. Complete cluster analysis dendrogram of the survey response data.

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