Identifying emerging hot spots of road traffic injury severity using spatiotemporal methods: longitudinal analyses on major roads in Ghana from 2005 to 2020.

BACKGROUND: Although road traffic injuries and deaths have decreased globally, there is substantial national and sub-national heterogeneity, particularly in low- and middle-income countries (LMICs). Ghana is one of few countries in Africa collecting comprehensive, spatially detailed data on motor vehicle collisions (MVCs). This data is a critical step towards improving roadway safety, as accurate and reliable information is essential for devising targeted countermeasures. METHODS: Here, we analyze 16 years of police-report data using emerging hot spot analysis in ArcGIS to identify hot spots with trends of increasing injury severity (a weighted composite measure of MVCs, minor injuries, severe injuries, and deaths), and counts of injuries, severe injuries, and deaths along major roads in urban and rural areas of Ghana. RESULTS: We find injury severity index sums and minor injury counts are significantly decreasing over time in Ghana while severe injury and death counts are not, indicating the latter should be the focus for road safety efforts. We identify new, consecutive, intensifying, and persistent hot spots on 2.65% of urban roads and 4.37% of rural roads. Hot spots are intensifying in terms of severity and frequency on major roads in rural areas. CONCLUSIONS: A few key road sections, particularly in rural areas, show elevated levels of road traffic injury severity, warranting targeted interventions. Our method for evaluating spatiotemporal trends in MVC, road traffic injuries, and deaths in a LMIC includes sufficient detail for replication and adaptation in other countries, which is useful for targeting countermeasures and tracking progress.

Behavioral traits that define social dominance are the same that reduce social influence in a consensus task.

Dominant individuals are often most influential in their social groups, affecting movement, opinion, and performance across species and contexts. Yet, behavioral traits like aggression, intimidation, and coercion, which are associated with and in many cases define dominance, can be socially aversive. The traits that make dominant individuals influential in one context may therefore reduce their influence in other contexts. Here, we examine this association between dominance and influence using the cichlid fish Astatotilapia burtoni, comparing the influence of dominant and subordinate males during normal social interactions and in a more complex group consensus association task. We find that phenotypically dominant males are aggressive, socially central, and that these males have a strong influence over normal group movement, whereas subordinate males are passive, socially peripheral, and have little influence over normal movement. However, subordinate males have the greatest influence in generating group consensus during the association task. Dominant males are spatially distant and have lower signal-to-noise ratios of informative behavior in the association task, potentially interfering with their ability to generate group consensus. In contrast, subordinate males are physically close to other group members, have a high signal-to-noise ratio of informative behavior, and equivalent visual connectedness to their group as dominant males. The behavioral traits that define effective social influence are thus highly context specific and can be dissociated with social dominance. Thus, processes of hierarchical ascension in which the most aggressive, competitive, or coercive individuals rise to positions of dominance may be counterproductive in contexts where group performance is prioritized.

"We are pleading for the government to do more": Road user perspectives on the magnitude, contributing factors, and potential solutions to road traffic injuries and deaths in Ghana.

Road traffic collisions disproportionately impact Ghana and other low- and middle-income countries. This study explored road user perspectives regarding the magnitude, contributing factors, and potential solutions to road traffic collisions, injuries, and deaths. We designed a qualitative study of 24 in-depth interviews with 14 vulnerable road users (pedestrians, occupants of powered 2- and 3-wheelers, cyclists) and ten non-vulnerable road users in four high-risk areas in November 2022. We used a mixed deductive (direct content analysis) and inductive (interpretive phenomenological analysis) approach. In the direct content analysis, a priori categories based on Haddon's Matrix covered human, vehicle, socioeconomic environment, and physical environment factors influencing road traffic collisions, along with corresponding solutions. We used inductive analysis to identify emerging themes. Participants described frequent and distressing experiences with collisions, and most often reported contributing factors, implementation gaps, and potential solutions within the human (road user) level domain of Haddon's Matrix. Implementation challenges included sporadic enforcement, reliance on road users' adherence to safety laws, and the low quality of the existing infrastructure. Participants expressed that they felt neglected and ignored by road safety decision-makers. This research emphasizes the need for community input for successful road safety policies in Ghana and other low- and middle-income countries, calling for greater governmental support an action to address this public health crisis. We recommend the government collaborates with communities to adapt existing interventions including speed calming, footbridges, and police enforcement, and introduces new measures that meet local needs.

Generating consensus on road safety issues and priorities in Ghana: A modified Delphi approach.

BACKGROUND: Implementation of evidence-based approaches to reduce the substantial health, social, and financial burdens of road traffic injuries and deaths in Ghana and other low-and-middle-income countries (LMICs) is vitally important. Consensus from national stakeholders can provide insight into what evidence to generate and which interventions to prioritize for road safety. The main objective of this study was to elicit expert views on the barriers to reaching international and national road safety targets, the gaps in national-level research, implementation, and evaluation, and the future action priorities. MATERIALS AND METHODS: We used an iterative three-round modified Delphi process to generate consensus among Ghanaian road safety stakeholders. We defined consensus as 70% or more stakeholders selecting a specific response in the survey. We defined partial consensus (termed "majority") as 50% or more stakeholders selecting a particular response. RESULTS: Twenty-three stakeholders from different sectors participated. Experts generated consensus on barriers to road safety goals, including the poor regulation of commercial and public transport vehicles and limited use of technology to monitor and enforce traffic behaviors and laws. Stakeholders agreed that the impact of increasing motorcycle (2- and 3-wheel) use on road traffic injury burden is poorly understood and that it is a priority to evaluate road-user risk factors such as speed, helmet use, driving skills, and distracted driving. One emerging area was the impact of unattended/disabled vehicles along roadways. There was consensus on the need for additional research, implementation, and evaluation efforts of several interventions, including focused treatment of hazardous spots, driver training, road safety education as part of academic curricula, promotion of community involvement in first aid, development of strategically positioned trauma centers, and towing of disabled vehicles. CONCLUSION: This modified Delphi process with stakeholders from Ghana generated consensus on road safety research, implementation, and evaluation priorities.

Injury-severity analysis of intercity bus crashes in Ghana: A random parameters multinomial logit with heterogeneity in means and variances approach.

Travel by bus is an efficient, cost-effective, safe and preferred means of intercity transport in many advanced countries. On the contrary, there is huge public sentiment about the safety records of intercity buses in low- and middle-income countries given the increasing bus-involved road traffic crashes and high fatality rates. This study sought to model the injury severity of intercity bus transport in Ghana using the random parameters multinomial logit with heterogeneity in means and variances modelling technique to account for unobserved heterogeneity in the dataset. The dataset involves crash data from the 575 km long Accra-Kumasi-Sunyani-Gonokrom highway in Ghana. Four discrete crash outcome categories were considered in this study: fatal injury, hospitalized injury, minor injury, and no injury. The study observed that crashes involving pedestrians, unlicensed drivers, and drivers and passengers aged more than 60 years have a higher probability of sustaining fatal injuries. Also, speeding, wrong overtaking, careless driving and inexperienced drivers were associated with fatal injury outcomes on the highway. The incidence of intercity bus transport crashes involving larger buses and minibuses were also found to more likely result in fatalities. The probability of hospitalized injury increased for crashes that occurred in a village setting. Given these findings, the study proposed improvement of the road infrastructure, enforcing seatbelt availability and use in intercity buses, increased enforcement of the traffic rules and regulations to deter driver recklessness and speeding as well as improving the luminance of the highways. Additionally, apps that have features for customers to rate intercity bus operators, the quality of services provided, and also have the option to report reckless driving activities can be developed to promote safe and inclusive public transport in the country.

Health impacts of changes in travel patterns in Greater Accra Metropolitan Area, Ghana.

BACKGROUND: Health impact assessments of alternative travel patterns are urgently needed to inform transport and urban planning in African cities, but none exists so far. OBJECTIVE: To quantify the health impacts of changes in travel patterns in the Greater Accra Metropolitan Area, Ghana. METHODS: We estimated changes to population exposures to physical activity, air pollution, and road traffic fatality risk and consequent health burden (deaths and years of life lost prematurely - YLL) in response to changes in transportation patterns. Five scenarios were defined in collaboration with international and local partners and stakeholders to reflect potential local policy actions. RESULTS: Swapping bus and walking trips for car trips can lead to more than 400 extra deaths and 20,500 YLL per year than travel patterns observed in 2009. If part of the rise in motorisation is from motorcycles, we estimated an additional nearly 370 deaths and over 18,500 YLL per year. Mitigating the rise in motorisation by swapping long trips by car or taxi to bus trips is the most beneficial for health, averting more than 600 premature deaths and over 31,500 YLL per year. Without significant improvements in road safety, reduction of short motorised trips in favour of cycling and walking had no significant net health benefits as non-communicable diseases deaths and YLL benefits were offset by increases in road traffic deaths. In all scenarios, road traffic fatalities were the largest contributor to changes in deaths and YLL. CONCLUSIONS: Rising motorisation, particularly from motorcycles, can cause significant increase in health burden in the Greater Accra Metropolitan Area. Mitigating rising motorisation by improving public transport would benefit population health. Tackling road injury risk to ensure safe walking and cycling is a top priority. In the short term, this will save lives from injury. Longer term it will help halt the likely fall in physical activity.

Evaluation of the effectiveness of traffic calming measures on vehicle speeds and pedestrian injury severity in Ghana.

Objectives: Each year, pedestrian injuries constitute over 40% of all road casualty deaths and up to 60% of all urban road casualty deaths in Ghana. This is as a result of the overwhelming dependence on walking as a mode of transport in an environment where there are high vehicular speeds and inadequate pedestrian facilities. The objectives of this research were to establish the (1) impact of traffic calming measures on vehicle speeds and (2) association between traffic calming measures and pedestrian injury severity in built-up areas in Ghana. Method: Vehicle speeds were unobtrusively measured in 38 selected settlements, including 19 with traffic calming schemes and 19 without. The study design used in this research was a matched case-control. A regression analysis compared case and control casualties using a conditional logistic regression. Results: Generally, the mean vehicle speeds and the proportion of vehicles exceeding the 50 km/h speed limit were significantly lower in settlements that have traffic calming measures compared to towns without any traffic calming measures. Additionally, the proportion of motorists who exceeded the speed limit was 30% or less in settlements that have traffic calming devices and the proportion who exceeded the speed limit was 60% or more in towns without any traffic calming measures. The odds of pedestrian fatality was significantly higher in settlements that have no traffic calming devices compared to those that have (odds ratio [OR] = 1.98; 95% confidence interval, 1.09-4.43). The protective effects of a traffic calming scheme that has a speed table was notably higher than those where there were no speed tables. Conclusion: It was clearly evident that traffic calming devices reduce vehicular speeds and, thus, the incidence and severity of pedestrian injuries in built-up areas in Ghana. However, the fact that they are deployed on arterial roads is increasingly becoming a road safety concern. Given the emerging safety challenges associated with speed calming measures, we recommend that their use be restricted to residential streets but not on arterial roads. Long-term solutions for improving pedestrian safety proposed herein include bypassing settlements along the highways to reduce pedestrians' exposure to traffic collisions and adopting a modern way of enforcement such as evidence-based laser monitoring in conjunction with a punishment regime that utilizes the demerit points system.

Assessment of vehicle speeds on different categories of roadways in Ghana.

Empirical evidence from road safety literature suggests that vehicular speed is an important risk factor in the incidence and severity of road traffic crashes globally. Speed studies are at rudimentary stages in developing countries, thus making vehicular speed research imperative. The main aim of the study was to establish two major speed parameters, namely, the mean and dispersion, and their implications for more extensive and long-term speed monitoring in Ghana. Research workers stationed themselves in a parked car and used a radar gun to unobtrusively measure the travelling speeds of 28,489 vehicles at 15 different inter-urban locations on three highway categories. Excessive speeding is very pervasive on all highway categories in Ghana. Travelling speeds through settlements where a speed limit of 50 km/hour is mandatory were particularly excessive. Generally, 98%, 90% and 97% of vehicles exceeded the posted speed limit of 50 km/hour on national, inter-regional and regional roads respectively. Mean speeds and speed dispersions (as assessed by the standard deviations) through built-up areas were 81.3 +/- 17.3 km/hour on national roads, 64.7 +/- 12.3 km/hour on inter-regional roads and 72.6 +/- 13.4, km/hour on regional roads. On rural undivided highways with an 80 km/hour speed limit, mean and speed dispersions were 90 +/- 18.9 km/hour on national roads, 80.1 +/- 16 km/hour on inter-regional roads and 84.4 +/- 15.6 on regional roads; also translating into 66%, 47% and 60% of vehicles exceeding recommended speeds. In all cases, speed dispersions were notably higher than the value of 10 km/hour generally found in developed countries. Excessive speeding and wide speed dispersions are highly prevalent on Ghana's highways. These factors likely account for the high incidence of traffic crashes and fatalities in Ghana. An integrated speed monitoring and control programme and by-passing small and medium settlements would be required for the reduction of speed-related crashes, fatalities and injuries.

Road safety implications of the blood alcohol concentrations among alcohol users exiting bars in northern Ghana.

OBJECTIVE: The main objective of this study was to establish the blood alcohol concentrations (BACs) of bar patrons relative to the legal (BAC) limit for Ghana and the international guideline on alcohol consumption. METHOD: A cross-sectional study design and a convenience sampling technique were used to collect data at selected bars in 2 cities, namely; Bolgatanga and Wa, in northern Ghana. A breathalyzer was used to measure the breath alcohol concentrations of participants exiting bars and face-to-face questionnaires were administered to participants to capture their accident histories, alcohol consumption patterns, and modes of transport they usually use to travel to their next destination after alcohol consumption. RESULTS: The mean BAC of bar patrons was 0.143 ± 0.096% (95% confidence interval, 0.127 to 0.160%). The mean BAC of males (0.156%) was significantly higher than the mean BAC of females (0.103%; p = 0.004). Sixty-two percent of participants were exiting the bars with BACs of more than the legal BAC limit and 44% of this proportion was at 0.150% or more. Fifty-one percent of participants indicated that they usually consume a mixture of alcoholic beverages consisting of homemade and factory-made drinks. Fifty-seven percent of participants who usually consume a mixture of drinks had BACs of 0.150% or above. Only 22% of females and 6% of males consume alcohol within their respective recommended low risk of 1 to 2 units and 1 to 4 units, respectively. A vast majority of participants (96%) reported that they usually engage in risky behaviors such as riding, walking, or driving to their next destination after consuming alcohol. CONCLUSION: Motorists were more likely to exit the bars with very high BACs. It is recommended that police should enforce the BAC law. In addition, in order to prevent harmful use of alcohol, the introduction of an alcohol consumption guideline in Ghana is recommended. Because alcohol consumption is increasing currently with motorization, it is also necessary to educate alcohol users about the number of drinks required to stay below the legal limit if they are motorists as well as other road users or to prevent long-term illnesses associated with excessive alcohol use.

Prevalence of alcohol among nonfatally injured road accident casualties in two level III trauma centers in northern Ghana.

BACKGROUND: Alcohol use is pervasive among motorists on the road in Ghana; however, we do not know the extent to which this behavior is implicated in road accidents in this country. OBJECTIVES: The main objective of this research was to establish the prevalence of alcohol in the blood of nonfatally injured casualties in the emergency departments (EDs) in northern Ghana. METHOD: Participants were injured road traffic crash victims, namely, pedestrians, cyclists, motorcyclists, and drivers seeking treatment at an ED. The study sites were 2 level III trauma centers located in Wa and Bolgatanga. Participants were screened for alcohol followed by breath tests for positive participants using breathalyzers. RESULTS: Two hundred and sixty-two accident victims visited EDs, 58% of whom were in Wa. Among the victims, 41% were hospitalized and 57% experienced slight injuries. The vast majority (76%) of the casualties were motorcyclists, 13% were pedestrians, 8% were cyclists, and 2% were drivers. Casualties who had detectable alcohol in their blood were predominantly vulnerable road users. In all, 34% of participants had detectable blood alcohol concentrations (BACs) and the mean BAC for all casualties who tested positive and could give definitive BACs was 0.2265 (226 mg/dl). The prevalence of alcohol use was 53% among cyclists, 34% among motorcyclists, 21% among pedestrians, and 17% among drivers. Male casualties were more likely to test positive for alcohol than females. In addition, the prevalence of alcohol was significantly higher among injured casualties in Bolgatanga compared to Wa. CONCLUSION: There was a high prevalence of alcohol use among nonfatally injured casualties in northern Ghana and injury severity increased with BAC. AUDIT screening in the hospital, alcohol consumption guideline, road safety education with an emphasis on minimizing or eliminating alcohol consumption, and enhanced enforcement of the BAC limit among motorists are recommended.

Assessment of the road safety performance of four roundabouts in Kumasi, Ghana.

Upgrade of the Ejisu-Kumasi section of the N6 saw the construction of roundabouts at selected intersections. Their use appears challenging particularly for vehicles with elevated Centre-of-Gravity. The objective of this study was to establish the relative risk of traffic accident deaths or hospitalized injuries at the roundabouts. Five-year crash data covering a 100 m stretch upstream and downstream of the roundabouts were analysed. A total of 119 crashes occurred with 18% casualty hospitalization and 12%fatalities. Compared with the Ejisu roundabout, fatal or hospitalized injuries were significantly higher at the Boadi (OR = 25.6, p = 0.0021) and Kwame Nkrumah University of Science and Technology Police Station Junctions (OR = 48.2, p < 0.001). Occupants of buses, heavy goods vehicles and riders of two wheelers were at elevated risk of deaths or serious injuries. Crash severity at the round abouts was aggravated by night-time, steep gradients and adverse cambers. It is recommended that, signalization and grade separation should be used in the current arrangement where appropriate.

Study of vehicle speeds on a major highway in Ghana: implication for monitoring and control.

OBJECTIVE: Vehicular speeds have been identified to be at the core of road accident severity and frequency globally. Whereas speed control is a fundamental priority and the cornerstone of road safety in the developed world, the subject is at rudimentary stages in most developing countries thus making research into vehicle speeds in developing nations imperative. The main aim of the study was to establish two major speed parameters, namely the mean speed and dispersion, and their implications for more extensive and long-term speed monitoring in Ghana. METHODS: Research workers stationed themselves in a parked car and used a radar gun to unobtrusively measure the travelling speeds of 4,163 vehicles over two 24-hour periods at two separate sites on one of the main inter-urban roads (Accra-Kumasi). Both sites were settled areas with posted speed limits of 50 km/hr. RESULTS: Over 95% of vehicles travelled above the posted speed limit of 50 km/hr. Vehicles on an average travelled at 87 km/hr, (95% CI=87, 88). Variation in speeds was wide, with a standard deviation of 18 km/hr for all classes of vehicles, and with a range of 40 to 187 km/hr. The highest vehicular speed was associated with the private car (97.6+/-18.3 km/hr) followed by large buses (93.6+/-13.3 km/hr) and the least was with heavy trucks (73.8+/-12.9 km/hr). CONCLUSION: The excessive vehicular speeds coupled with the wide speed variations explain in part the high incidence of traffic crashes and fatalities on the Accra-Kumasi highway. An integrated speed monitoring and control program, and realigning the highway to by-pass small and medium settlements would be required as a long-term measure for the reduction of speed-related road traffic crashes, fatalities, and injuries in Ghana.

Motorists' knowledge, attitudes and practices toward alcohol-impaired driving/riding in Ghana.

OBJECTIVES: The main objective of this study was to establish the knowledge, attitudes, and practices toward drink driving/riding as a risk factor for road traffic crashes in 3 regional capitals in Ghana. METHODS: The study used a face-to-face approach to randomly sample motorists who were accessing various services at fuel/gas stations, garages, and lorry terminals in 3 cities in Ghana. RESULTS: Over the previous 12 months, 24% of all motorists and 55% of motorists who were current alcohol users reported driving or riding a vehicle within an hour of alcohol intake. On average, motorists/riders who were current alcohol users consumed 4 standard drinks per drinking occasion. Generally, 83% of motorists who currently use alcohol walked, rode, or drove home after consuming alcohol away from their homes. Motorists/riders who reported drink driving were 4 times more likely to have had previous traffic violation arrests compared to those who reported no drink driving/riding (P =.001). Respondents were of the opinion that speeding was the major cause of traffic crashes, followed by driver carelessness, poor road conditions, inexperienced driving, and drink driving, in that order. Thirty-six percent of motorists who use alcohol had the perception that consuming between 6 and 15 standard drinks was the volume of alcohol that will take them to the legal blood alcohol concentration (BAC) limit of 0.08%. Compared to females, male motorists/riders were more likely to report drink driving (adjusted odds ratio [AOR] = 5.15; 95% confidence interval [CI], 2.31 to 11.47). Private motorists also reported a higher likelihood of drink driving compared to commercial drivers (AOR = 3.36; 95% CI, 1.88 to 6.02). Only 4% of motorists knew the legal BAC limit of Ghana and only 2% had ever been tested for drink driving/riding. CONCLUSION: The volumes of alcohol that motorists typically consume per drinking occasion were very high and their estimates of the number of drinks required to reach the legal BAC limit was also very high. Provision of authoritative information advising motorists about safe, responsible, or low-risk levels of alcohol consumption is imperative. Many traffic violations including drink driving were reported, thus suggesting a need for enhanced policing and enforcement. However, given the low level of knowledge of the legal BAC limit, educating motorists about how many drinks will approximate the legal BAC should be intensified prior to an increase in enforcement; otherwise, the desired outcome of enforcement may not be achieved.

Road accident fatality risks for "vulnerable" versus "protected" road users in northern Ghana.

BACKGROUND: Road traffic injuries (RTIs) are a serious epidemic that claims more than a million lives across the globe each year. The burden of RTIs is particularly pronounced in Africa and other low- and middle-income countries. The unfavorable disparity of the burden of road trauma in the world is largely attributable to unsafe vehicles, lack of appropriate road infrastructure, and the predominance of vulnerable road users (VRUs) in developing countries. However, little research exists in northern Ghana to highlight the scale and risk of death among road users. OBJECTIVE: The objective of this research was to establish the relative risk of death among road users in northern Ghana. METHODS: Crash data from police reports between 2007 and 2011 were analyzed for the Upper Regions of Ghana. Conditional probabilities and multivariable logistic regression techniques were used to report proportions and adjusted odds ratios (AORs), respectively. RESULTS: Generally, crashes in northern Ghana were extremely severe; that is, 35% of all injury related collisions were fatal. The proportion of fatal casualties ranged between 21% among victims of sideswipe collisions and 41% among pedestrians and victims of rear-end collisions. Though males were 6 times more likely to die than females overall, females were more likely to die as pedestrians (90% of all female casualty deaths) and males were more likely to die as riders/drivers (78% of all male casualty deaths). Pedestrians were 3 times more likely to die (odds ratio [OR] = 3.1; 95% confidence interval [CI], 2.4 to 4.1) compared with drivers/riders. Compared with drivers, the odds of death among cyclists was about 4 times higher (AOR = 3.6; 95% CI, 2.3 to 5.6) and about 2 times higher among motorcyclists (AOR = 1.6; 95% CI, 1.2 to 2.2). Compared with casualties aged between 30 and 59 years, children under 10 years and those aged 60 years and above were independently 2 times more likely to die in traffic collisions. CONCLUSION: Provision of requisite road infrastructure is vital for the safety of VRUs in northern Ghana. Cycle paths and lanes (for cyclists) as well as sidewalks (for pedestrians) in particular will separate VRUs from motorists and improve their safety. Enforcement of traffic laws particularly regarding helmet use, speeding, and alcohol use will be beneficial. Introduction of the demerit points system in the enforcement of traffic regulations may have significant deterrent effects on road users who have the penchant for violating traffic regulations. Road safety education is also required to create responsible road users.

Prevalence of alcohol-impaired driving and riding in northern Ghana.

OBJECTIVE: The objective of this study was to determine the roadside prevalence of alcohol-impaired driving among drivers and riders in northern Ghana. The study also verifies motorists' perceptions of their own alcohol use and knowledge of the legal blood alcohol concentration (BAC) limit in Ghana. METHOD: With the assistance of police, systematic random sampling was used to collect data at roadblocks using a cross-sectional study design. Breathalyzers were used to screen whether motorists had detectable alcohol in their breath and follow-up breath tests were conducted to measure the actual breath alcohol levels among positive participants. RESULTS: In all, 9.7% of the 789 participants had detectable alcohol, among whom 6% exceeded the legal BAC limit of 0.08%. The prevalence of alcohol-impaired driving/riding was highest among cyclists (10% of all cyclists breath-tested) followed by truck drivers (9%) and motorcyclists (7% of all motorcyclists breath-tested). The occurrence of a positive BAC among cyclists was about 8 times higher (odds ratio [OR] = 7.73; P < .001) and it was 2 times higher among motorcyclists (OR = 2.30; P = .039) compared to private car drivers. The likelihood for detecting a positive BAC among male motorists/riders was higher than that among females (OR = 1.67; P = .354). The odds for detecting a positive BAC among weekend motorists/riders was significantly higher than on weekdays (OR = 2.62; P = .001). CONCLUSION: Alcohol-impaired driving/riding in Ghana is high by international standards. In order to attenuate the harmful effects of alcohol misuse such as alcohol-impaired driving/riding, there is the need to educate road users about how much alcohol they can consume and stay below the legal limit. The police should also initiate random breath testing to instill the deterrence of detection, certainty of apprehension and punishment, and severity and celerity of punishment among drink-driving motorists and riders.

Observed seat belt use in Kumasi Metropolis, Ghana.

We conducted an observational survey of seat belt use to determine the use rate of drivers and front-right passengers of vehicles in Kumasi, Ghana. Unobtrusive observations of seat belt use were made at 41 locations composed of signalized intersections and roundabouts where vehicles come to a halt or slow down considerably. The overall driver seat belt use rate was 17.6% compared to 4.9% for front-right passengers. Driver belt use was 33.2% for private cars, 9.0% for taxis, 8.3% for minibus (trotro), 13.1% for large buses and 9.7% for trucks. Overall seat belt use was higher for female drivers than for male drivers (44.8% versus 16.4%, p < .001), was lowest within the Central Business District (CBD) compared to the outskirts of the city (16.3% versus 21.0%, p < .001) and seat belt use rate increased with age. Passengers belted more often if drivers were belted, but about three-quarters of male passengers and 70-80% of female passengers were unbelted even when drivers were belted. In conclusion, the seat belt use rate was generally low in Kumasi, Ghana, and it is a function of occupant seating position, gender, vehicle type and usage, age group, and location setting. The results provide important preliminary data about seat belt use, particularly among male drivers and commercial vehicle occupant population. The study also suggests the need to develop effective strategies and programs that address low seat belt use in Ghana.

Pedestrians' injury patterns in Ghana.

OBJECTIVE: To establish the associations between pedestrian injury and explanatory variables such as vehicular characteristics, temporal trends, and road environment. METHODS: A retrospective analysis of de-identified pedestrian crash data between 2002 and 2006 was conducted using the Building & Road Research Institute's crash data bank. We estimated the odds ratios associated with casualty fatalities using a multinomial logistic regression. RESULTS: There were 812 pedestrian casualties reported, out of which 33% were fatal, 45% sustained serious injuries requiring hospitalization, and 22% were slightly injured but were not hospitalized. Crossing the roadway accounted for over 70% of all pedestrians' deaths. Whereas fatalities in 2002 and 2003 were statistically indistinguishable from those of 2004 (p>0.05), in comparison with 2004, there were significantly fewer fatalities in 2005 and 2006 (78% and 65% reduction respectively). According to police report, the probability that a pedestrian fatality occurring in Ghana attributable to excessive speeding is 65%. The adjusted odds ratio of pedestrian fatality associated with speeding compared with driver inattentiveness was 3.6 (95% CI: 2.5-5.2). It was also observed that generally, lighter vehicular masses were associated with lower pedestrian fatalities. Compared with buses, pedestrians were less likely to die when struck by private cars (52%), pick-up trucks (57%), and motorcycles (86%). CONCLUSION: Pedestrian death remains the leading cause of fatality among urban road users in Ghana. Risk factors associated with pedestrian fatality include being hit by heavy vehicles, speeding, and roadside activities such as street hawking, jaywalking and nighttime walking. Steps which may contribute to reducing pedestrian fatalities include measures to reduce vehicles speeds in settlements, providing traffic medians and lighting streets in settlements, and discouraging street and roadside activities such as hawking.