Road Traffic Injuries and Data Systems in Egypt: Addressing the Challenges

Figures & data

Figure 1 Modeled deaths due to road traffic injuries per 100,000 population in the Eastern Mediterranean region. Source: Global Burden of Disease Update (World Health Organization 2004) (color figure available online).

Table I Characteristics of the WHO Eastern Mediterranean Region.

Countries	High income	Middle income	Low income	All
Population	33.6 million	299 million	213 million	545.6 million
% of global population	3.3	9.6	8.9	8.3
Vehicles	11.5 million	34.4. million	6.8 million	52.7 million
% of global vehicles	1.7	6.7	5.6	4
Source: Global Status Report on Road Safety (WHO 2009a).

Figure 2 Flowchart summarizing literature review process for Egypt.

Table II Summary of literature review

Author (date)	Type of study	Location	Study population	Results	Conclusions/ Recommendations
Behavioral/perception/attitude studies
Day et al. (2010)	Cross-sectional	Cairo, Egypt	28 Young Egyptians (14–26 years of age) of medium to high socioeconomic status	The majority of the respondents believed that road traffic crashes are hadthah (accidents/out of one's control) rather than esabah (injuries) Education, enforcement, and engineering were recommended as intervention tactics	Young Egyptians of medium to high socioeconomic status were found to be receptive toward injury prevention programs. However, it is important to understand how these injury concepts are perceived (hadthah or esabah)
Islam et al. (1974)	Cross-sectional	Cairo, Egypt	55 Public transport drivers	Compared to normal drivers, neurotic and accident-prone drivers received a significantly higher score for neuroticism The neuroticism scores of accident-prone drivers were the highest amongst the three groups	Preemployment personality screenings were suggested
Rady (1997)	Cross-sectional	Cairo, Egypt	382 Physicians at Ain Shams University Hospital	11.2% of the participants used a seat belt regularly	Need intervention programs to reduce behavioral risk factors among physicians and laws that mandate seat belt use
Hospital-based studies
Abou-Raya and ElMeguid (2009)	Cross-sectional	Alexandria, Egypt	258 Elderly (65 years and +) road traffic injury patients	Elderly males were at higher risk for RTIs 57% of elderly RTI victims were pedestrians, 26% were car drivers, 14% were car passengers, 2.7% were bicyclists, and 0.7% were motorcyclists	Health and transport professionals must work together to prevent RTIs in vulnerable populations Recommendations include improving motor vehicle and road designs as well as offering frequent medical screenings
Al-Refaie et al. (2009)	Retrospective	Mansoura, Egypt	46 Blunt traumatic diaphragmatic rupture patients	The main cause of blunt traumatic diaphragmatic rupture was road traffic crashes (78.3%) Of the 46 patients, 2 (4.3%) died Blunt traumatic diaphragmatic rupture was more common in men in their 40s	Blunt traumatic diaphragmatic rupture was most common in men who have been involved in road traffic crashes
Hassan et al. (2010)	Cross-sectional	Tanta, Egypt	255 Patients with craniofacial injuries	Road traffic crashes were the most common cause of craniofacial injuries (54.12%) There were a higher percentage of males involved in traffic crashes (45.88%) compared to females (7.06%)	Engineering, enforcement, and education were recommended to decrease the number of craniofacial injuries
Sakr et al. (2006)	Retrospective	Alexandria, Egypt	509 Mandibular fracture patients	The main cause of mandibular fracture was road traffic crashes (39%) Among male patients, road traffic crashes were the leading cause (42%). On the other hand, among female patients, road traffic crashes were the second leading cause (36%) Among all road traffic crash patients, individuals between 21 and 30 years were at the highest risk (39%)	Results agreed with previous research
Modeling
Abbas (2004)	Statistical modeling	Rural roads in Egypt	N/A	The death per million vehicle kilometers in Egypt was 44.1. This was 34 times higher than G-7 countries and 3 times higher than other Middle Eastern countries Over the past 5 years, there has been a decrease in risk-based, causalities, and injury severity indicators but an increase in fatalities severity indicators	Recommendations included increasing the awareness of drivers regarding the importance of inspecting tires and observing speed limits. It is also necessary to implement tougher driver tests and ensure the presence of road signs and road shoulders
Secondary analysis
Hammam (1968)	Secondary data	United Arab Republic	N/A	Of all accident-related deaths in United Arab Republic, 2.8% could be attributed to motor vehicle crashes Urban areas experienced higher rates of motor vehicle related case-fatality compared to rural regions Males were found to be at higher risks of motor vehicle related fatality than females at all ages	Accident prevention program was recommended
Hamam et al. (1999)	Secondary data	Egypt		RTIs were the leading cause of injury-related deaths RTIs were responsible for 56% and 53% of all injury related deaths in rural and urban areas, respectively Victims of RTIs included pedestrians (67%), car occupants (14%), cyclists (7%), and motorcyclists (4%).	Recommendations included improving death registration system; conducting population-based, case-control, and cohort studies; and gaining endorsements from the national committee and safety council to collect injury-related data
Surveillance
El Din (2010)^a	Surveillance	Cairo, Egypt	N/A	Development of a surveillance database system. During the study period, there were 594 traffic crashes, which resulted in 992 injured and 51 dead Road traffic injury rate per 100,000 population in Cairo was 52.9 and road traffic death rate per 100,000 population in Cairo was 2.7 Most victims were male (82.2%) and 40 years or younger (73.6%) 52% of the victims were pedestrians	Recommendations included standardizing data collection system, educating young drivers and child pedestrians, improving road designs, adopting safety laws, creating a national road safety council, increasing the number of ambulances during holidays, and improving EMS performance
El Din (2006)	Surveillance	Egypt	N/A	In 2007, there were 6345 accidents, of which 5403 or 85% were due to road traffic crashes Road traffic crashes contributed to 29,855 injuries and 2416 deaths Giza, Cairo, and Elbehra governorates had the highest percentages of road traffic crashes	Recommendations included increasing the number of ambulances during holidays, forming mobile or static ambulance squads, improving emergency medical service performance, introducing safety laws, and standardizing data collection systems
Saad (2008)	Newspaper surveillance	Egypt	N/A	There were 1221 deaths, of which 48.89% were due to RTIs Among train, trucks, and car users, the latter group experienced the highest percentage of RTI deaths (51.01%) The percentage of RTI deaths compared to assault and drowning-related deaths is highest in the Red Sea governorate (92.86%)	Egypt's mortality registry can be enhanced with the use of public newspapers
Regional/global studies
El-Zawahry (1967)	Secondary data	Multi-country (inclusive of United Arab Republic)	N/A	United Arab Republic (UAR)-specific results: The UAR experienced the highest rates of accidents in general but the lowest rate of road traffic accidents Males were at greater risks for accidents The UAR experienced high risk of accidents but the proportion of case-fatalities was low compared to all other deaths	N/A
Hyder (2009)	Cross-sectional	Multi-country (Bangladesh, Colombia, Egypt, and Pakistan)	1559 Injured children (≤12 years)	Egypt-specific information: About 32% of the 1559 child patients were from Egypt Pooled results showed that: 350 Children suffered road traffic injuries, of which 39% were pedestrians, 19% were passengers of 4-wheelers, and 13% were passengers of 2-wheelers About 5% of the children wore seat belts or helmets 20 Children needed emergency surgery and 2 died	The authors concluded that it is feasible to assess childhood injuries and use standardized injury surveillance in LMICs It was recommended that pedestrian safety be incorporated into interventions
Jacobs and Sayer (1982)	Secondary data Analysis	Multi-country (inclusive of Egypt)	N/A	Pooled results show that: RTI-related fatality rates per vehicles were higher in developing countries compared to developed countries RTIs cost about 1% of the annual gross national product of developing countries RTIs were found to be a growing health and economic problem for developing countries	Recommendations included improving education, training, and enforcement as well as implementing cost-effective interventions
Smith and Barss (1991)	Secondary data analysis	Multi-country (inclusive of Egypt)	N/A	Egypt-specific information: Crude case-fatality rate was 4 per 100,000 population in males and 2 per 100,000 population in females Pooled results showed that: In most of the developing world, motor vehicle crashes were the leading cause of death from unintentional injuries Males were about 5 times more likely than females to experience RTI-related deaths RTI-related fatality rates per population, vehicles, and miles traveled have increased in the developing world	Recommendations included prioritizing causal factors, using epidemiologic surveillance of injuries, ensuring accurate recording, and conducting surveys as well as population-based prospective studies
Wintemute (1984)	Secondary data analysis	Multi-country (inclusive of Egypt)	N/A	Egypt-specific information: In 1978, crude case-fatality rate per 100,000 persons was 2.1. The proportional case-fatality rate for motor vehicle–related fatality to all deaths was 0.2, and the percentage of all RTI-related deaths was 4.4 Pooled results showed that: The relationship between economic development and RTI deaths was found to be weak if not nonexistent Income distribution in low-income countries had a stronger relationship to RTI-related deaths	RTI interventions were recommended to be country-specific because the determinants of RTI-related case-fatality vary across countries
Wintemute (1985)	Secondary data analysis	Multi-country (inclusive of Egypt)	N/A	Pooled results showed that: The relationship between economic development (GNP per capita) and RTI deaths was found to be weak RTI fatality rates were increasing most quickly in low- and middle-income countries. However, this relationship was not straightforward	Future studies that focused on examining noneconomic determinants were recommended
^aPersonal communication, April 10–15, 2010, Cairo, Egypt.

Table III Sources of road traffic injury data, Egypt 2001 to 2009

Data type	Responsible organization	Year(s)	Key indicators available	Comments
National hospital-based injury surveillance	Ministry of Health	1999–2009	For all injury types: Crash location Facility Demographics Place of injury External cause of injury Type of injury Diagnosis Outcome Period of admission Referrals	All national government and teaching/university hospitals.
Community-based health survey	WHO	2009	Proportion of RTI fatalities of all deaths Leading causes of death Demographics Crash location Road user categories Safety intervention use Activity at time of crash Economic data	Nationally representative sampling (PPS)—5 governorates (Alexandria, Cairo, Assuit, Sharkia, Dakhlia) 11,118 households 47,797 individuals
Pre-hospital injury surveillance	Ministry of Health	2008	Fatalities Injuries Crashes Demographics Month/day/time Crash location Vehicle involved External cause of injury Diagnosis Paramedic performance Referrals	Two types of surveillance—one active and one combined active and passive surveillance. Accessible data are from this second form of surveillance and only account for severe, multivehicle crashes
Police	Ministry of Interior		Crash location Date/time Weather/road surface Mode of transport of injured Type of vehicle Vehicle behavior Cause of crash Demographics Driver license Type of injury	Unable to access this data^a
GARBLT			Crash location Date/time Weather/road surface Mode of transport of injured Type of vehicle Vehicle behavior Cause of crash	Looks at 10 national highways, one of which is the Cairo Ring Road. Additional roads to be added as part of RS10 will include the Alexandria roads
Death certificates			Date of death Demographics (name, age, sex, occupation) Place of death Address Cause of death Road user categories Type of vehicle
CAPMAS/Ministry of Interior		2001–2009	Crashes Injuries Deaths Number of vehicles damaged Crash location	Data sourced from Ministry of Interior. Delays in making data publicly available. ^a
^aAs of December 31, 2010.

Figure 3 Rate of crashes per 100,000 population in Egypt, 1990 to 2009. Source: Central Agency for Public Motorization and Statistics (2009).

Figure 4 Rate per 100,000 population of nonfatal road traffic injuries by age and gender in Egypt. Source: hospital-based surveillance system (Ministry of Health 2009).

Figure 5 Rate of road traffic fatality per 100,000 population by age and gender. Source: mortality information systems (Ministry of Health 2009).

Table IV Overview of the strengths and weaknesses of select data sources for road traffic injury in Egypt, 2010

Data source	Strengths	Weaknesses
Mortality information systems	Well-established reporting system in place (CAPMAS) that all health and other injury-related authorities such as the Ministry of Interior, Ministry of Transport, and traffic police, are mandated to report deaths to	Definition of road traffic death does not include 30-day follow-up Underreporting of injury deaths due to inaccurate coding practices No formal evaluation of the data system has been carried out
Hospital-based injury surveillance	System collects all injured victims who present to emergency departments in select facilities Revised surveillance forms in keeping with international guidelines using ICD-10 coding Started including university hospitals in the national injury surveillance system in 2009	Until 2008, the coverage represented 53% of the reporting facilities (Ministry of Health faculties) Follow-up of patients for 30 days not carried out routinely No reporting for injury severity scores or degree of caused disabilities
Pre-hospital injury surveillance	Two surveillance systems in place—a passive one and a combined active/passive system The passive system accounts for all 29 ambulance fleets and gives details of all missions	Passive system not routinely used for monitoring and assessment of RTI burden The combined active/passive approach only represents 6%, 23%, and 48% of crashes, injuries, and deaths, respectively, in Egypt Looks at multivehicle crashes only
Police	Traffic police have a strong research department in place and are continuously improving their reporting systems Report some data to CAPMAS, which publish them in special report	Not all crashes and injuries are reported to police; therefore, underreporting exists
Community-based injury survey, 2009	Covered 5 governorates and used strong statistical sampling techniques Covered all injuries and included modules on risk factors and socio-economic costs	Small sample sizes of RTIs mean that survey results may not be generalizable to a national level Recall bias 21 Governorates excluded

Figure 6 Road traffic fatality rate by year, 2004 to 2008. Source: CAPMAS (2009).

Table V Comparison of data key data sources for road traffic deaths and injuries, 2007

	Data source
Indicator	Ministry of Interior (from GSRRS)	Mortality information systems	Pre-hospital surveillance	Hospital-based surveillance
Number of road traffic fatalities, 2007	12,295	7145	4205	1657
Number of road traffic injuries, 2007	154,000	n/a	n/a	86,244

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