Factors associated with the severity of road traffic injuries from emergency department based surveillance system in two Mexican cities.

BACKGROUND: Limited data from low- and middle-income countries (LMICs) on the severity of road traffic injuries (RTIs) and their relation to different variables of interest are routinely obtained. Knowledge on this subject relies on evidence from high-income countries, which might not be the same as in LMICs. This information is greatly needed to advance and inform local and regional efforts towards the United Nations' Decade of Action and the Sustainable Development Goals. METHODS: From May 2012 to November 2014, a RTI surveillance system was implemented in two referral hospitals in two Mexican cities, León and Guadalajara, with the objective of exploring the relationship between Injury Severity Score (ISS) and different sociodemographic characteristics of the injured as well as different variables related to the event and the environment. All individuals suffering RTIs who visited the Emergency Rooms (ER) were included after granting informed consent. A Zero-Truncated Negative Binomial Model was employed to explore the statistical association between ISS and variables of interest. RESULTS: 3024 individuals participated in the study: 2185 (72.3%) patients from León and 839 patients (27.7%) from Guadalajara. Being male, in the 20-59 age-group, having less schooling, events occurring in Guadalajara, on Sundays, at night, and arriving at ER via public/private ambulance were all associated with an increased log count of ISS. Found a significant interaction effect (p-value< 0.05) between type of road user and alcohol intake six hours before the accident on severity of the injury (ISS). The use of illicit drugs, cellphones and safety devices during the event showed no association to ISS. CONCLUSIONS: Our study contributes to the statistical analysis of ISS obtained through RTI hospital surveillance systems. Findings might facilitate the development and evaluation of focused interventions to reduce RTIs in vulnerable users, to enhance ER services and prehospital care, and to reduce drink driving.

Pattern of presenting complaints recorded as near-drowning events in emergency departments: a national surveillance study from Pakistan.

BACKGROUND: Drowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap. METHODS: Patients who presented with a complaint of "near-drowning" were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the "near-drowning" complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization. RESULTS: A total of 133 patients (0.2% of all injury patients) with "near-drowning" as presenting complaints were recorded by the Pak-NEDS system. True near-drowning (50.0%) and intentional injuries that led to "near-drowning" complaints (50.0%) differed in nature of injuries. The highest proportion of true near-drowning incidents occurred among patients aged between 25-44 years (47.5%), and among males (77.5%). True near-drowning patients usually had other accompanying complaints, such as lower limb injury (40.0%). Very few patients were transported by ambulance (5.0%), and triage was done for 15% of patients. Eleven (27.5%) true near-drowning patients received cardiopulmonary resuscitation. CONCLUSION: There was major under-reporting of drowning and near-drowning cases in the surveillance study. The etiology of near-drowning cases should be further studied. Patients who experienced non-fatal drownings were more commonly sent for medical care due to other accompanying conditions, rather than near-drowning event itself. There is also need for recognizing true near-drowning incidents. The results of this study provide information on data source selection, site location, emergency care standardization, and multi-sector collaboration for future drowning prevention studies.

The prevalence of motorcycle helmet use from serial observations in three Mexican cities.

Motorcycle use as a functional and recreational means of transportation is increasing in Mexico; the associated mortality rate has also increased. Appropriate helmet use can reduce a motorcyclist's risk of death or serious injury. This study quantified the prevalence of motorcycle helmet use in three Mexican cities (Cuernavaca, Guadalajara-Zapopan, and León) within the context of several ongoing road safety initiatives. Four rounds of roadside observations were conducted between November 2010 and April 2012. The overall prevalence of helmet use was 73.8% among all users; helmet use was much lower among females (55.3%). Drivers tended to use helmets more frequently than passengers (76.3% vs. 51.6%). The prevalence was higher in León (85.9%, 95% CI = 84.8-87.0) than Cuernavaca (71.5%, 95% CI = 69.3-73.6) and Guadalajara-Zapopan (62.7%, 95% CI = 61.1-64.2). Helmet use decreased in León (p = 0.003) but increased in Guadalajara-Zapopan (p = 0.000) during this period. Motorcycle helmet use could be improved in all three cities. Since motorcycle use is increasing, interventions targeting motorcycle users and greater enforcement of helmet use are necessary to reduce crashes and non-fatal and fatal injuries.

Global childhood unintentional injury study: multisite surveillance data.

OBJECTIVES: We aimed to analyze the epidemiology of childhood unintentional injuries presenting to hospitals in 5 select sites in low- and middle-income countries (LMICs) (Bangladesh, Colombia, Egypt, Malaysia, and Pakistan). METHODS: We collected standardized data from children ages 0 to 12 years at participating emergency departments (EDs) in 2007. Statistical analyses were conducted to compare the characteristics of these injuries and to explore the determinants of injury outcomes. RESULTS: Among 2686 injured children, falls (50.4%) and road traffic injuries (16.4%) were the most common, affecting boys more often (64.7%). Home injuries were more common among younger children (average 5.41 vs 7.06 years) and girls (38.2% vs 31.7%). Following an ED visit, 24% of injured children were admitted to the hospital, and 6 died. Injury outcomes were associated with risk factors, such as age and sex, to varying extents. CONCLUSIONS: Standardized ED surveillance revealed unintentional injuries are a threat to child health. The majority of events took place inside the home, challenging traditional concepts of children's safety and underscoring the need for intensified context-appropriate injury prevention.

The prevalence of mobile phone use among motorcyclists in three Mexican cities.

OBJECTIVE: To quantify the prevalence of mobile phone use among motorcyclists in 3 Mexican cities and to identify associated factors. METHODS: Two rounds of roadside observations were conducted in Guadalajara-Zapopan, León, and Cuernavaca from December 2011 to May 2012. Observation sites were selected randomly and all motorcyclists circulating at those sites were recorded. Motorcyclists observed talking into a phone (either handheld or hands-free) or texting were recorded as using a mobile phone while driving. RESULTS: A total of 4244 motorcyclists were observed. The overall prevalence of mobile phone use was 0.64 percent (95% confidence interval [CI]: 0.42-0.92); it was highest in Guadalajara-Zapopan (1.03%; 95% CI: 0.61-1.63) and among motorcyclists not using a helmet (1.45% versus 0.4%; P = .000) and those riding on 1-lane roads (1.6% versus 0.8% on 2-lane roads and 0.5% in 3- to 5-lane roads; P = .046). CONCLUSIONS: To our knowledge this is the first study that reports the prevalence of mobile phone use while driving among motorcyclists. The observed prevalence is higher than the prevalence stated in a previous report from China on electric bicycle riders. This risk factor should be monitored in the future given the growing popularity of motorcycles and the availability of mobile devices. Current legislation should be enforced to avoid potential injuries and deaths attributable to this risk factor.

The use of seatbelts and child restraints in three Mexican cities.

Seatbelts and child restraints can reduce deaths resulting from road traffic crashes, and are one of the risk factors being targeted by the Road Safety in 10 Countries project in Mexico. This study quantifies the prevalence of restraint use in two of the intervention sites (Guadalajara-Zapopan and León) and one comparison site (Cuernavaca). Three rounds of roadside observations were conducted between November 2010 and January 2012. The overall prevalence of seatbelt use was 45.0% (95% CI = 44.3-45.7) amongst all occupants ≥10 years of age in the three cities. Child restraint use in children <5 years of age ranged from 7.9 to 17.4%. Two rounds of surveys were administered to all road traffic injury (RTI) victims presenting at a tertiary hospital in each city; RTI victims had lower seatbelt use than the general population (31% vs 42%, p = 0.037). This study demonstrates the need for further targeted intervention to increase use of these highly efficacious safety devices in Mexico.

Distracted driving: mobile phone use while driving in three Mexican cities.

Mexico has a significant road traffic injury and mortality burden, and several states/municipalities have begun passing legislation restricting mobile phone use while driving (MPUWD). Little information is available about the prevalence of MPUWD in Mexico. This study measures the prevalence of mobile phone talking and texting among drivers in three cities, and identifies associated demographic and environmental factors. Two rounds of roadside observations from a group of randomly selected automobile drivers were conducted during 2011-2012 in Guadalajara-Zapopan, León and Cuernavaca. The overall prevalence of MPUWD was 10.78%; it was highest in Guadalajara-Zapopan (13.93%, 95% CI 12.87 to 15.05), lowest in Cuernavaca (7.42%, 95% CI 6.29 to 8.67), and remained stable over two rounds of observations, except for León, where the prevalence increased from 5.27% to 10.37% (p=0.000). Driving alone on major roads in non-taxi cars during the weekdays was associated with MPUWD. Results highlight the importance of studying the risk of mobile phone use, and designing and evaluating specific preventive interventions to address this problem in Mexico.

Challenges associated with drunk driving measurement: combining police and self-reported data to estimate an accurate prevalence in Brazil.

BACKGROUND: Drunk driving is an important risk factor for road traffic crashes, injuries and deaths. After June 2008, all drivers in Brazil were subject to a "Zero Tolerance Law" with a set breath alcohol concentration of 0.1 mg/L of air. However, a loophole in this law enabled drivers to refuse breath or blood alcohol testing as it may self-incriminate. The reported prevalence of drunk driving is therefore likely a gross underestimate in many cities. OBJECTIVE: To compare the prevalence of drunk driving gathered from police reports to the prevalence gathered from self-reported questionnaires administered at police sobriety roadblocks in two Brazilian capital cities, and to estimate a more accurate prevalence of drunk driving utilizing three correction techniques based upon information from those questionnaires. METHODS: In August 2011 and January-February 2012, researchers from the Centre for Drug and Alcohol Research at the Universidade Federal do Rio Grande do Sul administered a roadside interview on drunk driving practices to 805 voluntary participants in the Brazilian capital cities of Palmas and Teresina. Three techniques which include measures such as the number of persons reporting alcohol consumption in the last six hours but who had refused breath testing were used to estimate the prevalence of drunk driving. RESULTS: The prevalence of persons testing positive for alcohol on their breath was 8.8% and 5.0% in Palmas and Teresina respectively. Utilizing a correction technique we calculated that a more accurate prevalence in these sites may be as high as 28.2% and 28.7%. In both cities, about 60% of drivers who self-reported having drank within six hours of being stopped by the police either refused to perform breathalyser testing; fled the sobriety roadblock; or were not offered the test, compared to about 30% of drivers that said they had not been drinking. DISCUSSION: Despite the reduction of the legal limit for drunk driving stipulated by the "Zero Tolerance Law," loopholes in the legislation permit many drivers under the influence of alcohol to act with impunity. In this context the police/traffic officers are often powerless to enforce the law and thus drunk driving continues to go unchecked. CONCLUSION: Strong legislation and effective enforcement are necessary to reduce the prevalence of this dangerous behaviour. Correction techniques allow calculation of a truer prevalence of drunk driving, which can assist police and policymakers alike to redirect resources and align strategies.

Attitude change in youths after being exposed to different road safety interventions in two Mexican cities.

OBJECTIVE: To assess the reach of three different types of road safety interventions (social marketing, education and law enforcement) implemented as part of the Iniciativa Mexicana de Seguridad Vial y Prevención de Lesiones en el Tránsito (Mexican Initiative for Road Safety and the Prevention of Road Traffic Injuries) among youth in two Mexican cities (Guadalajara-Zapopan, Jalisco and León, Guanajuato), and to examine students' self-reported attitude change after being exposed to these interventions. METHODS: A cross-sectional design was utilized to evaluate the reach of the city-wide interventions among a random sample of public and private high school and college students from October to December 2011. A total of 5,114 students completed a self-administered questionnaire. RESULTS: In both cities, students reported a greater exposure to social marketing (73% in Guadalajara-Zapopan and 64% in León) as compared to educational interventions (29.3% in León and 21.6% in Guadalajara-Zapopan) and law enforcement activities (~12% in both). Among respondents, self-reported attitude change was higher after being exposed to educational interventions than law enforcement. Social marketing yielded the lowest prevalence of self-reported attitude change. DISCUSSION: Our results show a potential moderate impact, measured as self-reported attitude change, resulting from the three intervention approaches under study. Future studies should address the intensity of exposure as well as the translation of attitude change into safer behaviors. Information generated by this study could be useful for local authorities in the intervention areas to inform their activities.

Quantifying the underestimated burden of road traffic mortality in Mexico: a comparison of three approaches.

INTRODUCTION: We present a novel multistep technique to estimate the actual burden of road traffic mortality in Mexico during the time period 1999 to 2009 by comparing 3 approaches for redistribution of nonspecific ("garbage") International Classification of Diseases (ICD)-coded deaths. METHODS: Road traffic (RT) mortality data were extracted using a secondary analysis of the Mexican mortality databases for the period 1999 to 2009. In an attempt to correct for underestimation due to inappropriately coded deaths, those deaths assigned to nonspecific codes were redistributed utilizing 3 different adjustment methods. A comparison of the 3 adjustment approaches (proportional, multiple imputation, and regression) is presented. A Poisson regression analysis was utilized to model mortality trends in the raw data and the 3 estimates. RESULTS: After adjustments, the total number of RT deaths increased by 18 to 45 percent, showing significant underestimation when only the raw data are used. All 3 approaches showed statistically significantly higher RT mortality rates than the crude figures. The proportional approach resulted in the highest RT mortality rate estimate of 23 per 100,000 in 2009 and showed a statistically significant positive increase of 1.5 percent per year across the decade. The 60+ age group and pedestrians had the highest mortality rates of 40 and 10.3 per 100,000, respectively. Over the decade, there was an alarming 332 percent increase in the mortality rate for male motorcyclists. CONCLUSION: Though efforts to improve coding should continue to be implemented, we present an additional and often overlooked contribution to the underestimation of road traffic mortality: the ICD nonspecific codes. Improved estimates of road traffic mortality are important in Mexico for policy change and decision making, highlighting the importance of targeting road traffic deaths as a public health problem. The approach presented here may also be useful for estimating the burden of other deaths with similar coding problems.

Drinking and driving in Vietnam: public knowledge, attitudes, and practices.

OBJECTIVE: Injuries are among the 10 leading causes of death for all ages in Vietnam, and road traffic fatalities account for approximately half of those deaths. Despite having what is considered to be one of the most stringent alcohol legislations in the region, alcohol involvement in road traffic crashes remains high. This study aims to illustrate the knowledge, attitudes, and practices around alcohol use and drinking and driving by age and sex in 3 provinces in Vietnam. METHODS: This study was conducted between January and February 2011, surveying randomly selected road users over the age of 17 years at gas stations in 3 provinces: Ha Nam, Ninh Binh, and Bac Giang, Vietnam. Data were collected for one week at each gas station. A knowledge, attitudes, and practices (KAPs) survey was administered in 7 time blocks of 90 min throughout the day, from 07:30 am to 9:30 pm. RESULTS: There were a total of 633 respondents almost evenly divided among the 3 provinces. Males accounted for 69.1 percent of respondents; the majority were 36 years of age or younger. Despite the belief that drinking and driving will increase the risk of a crash, a significant proportion of respondents (44.9%) reported drinking and driving; 56.7 percent admitted to drinking and driving within the last month. Drinking and driving was more common among males, with approximately 60.2 percent indicating a history of drinking and driving. This proportion was particularly high among males aged 17 to 26 (71.4%). It was found that preferred alternatives to drinking and driving when available were leaving with a nondrinker (42%), resting until "feeling conscious" (23%), and drinking less (20%). CONCLUSIONS: This study shows that, in general, alcohol use and drinking and driving remain a problem in Vietnam, a major concern given that the country is rapidly motorizing and likewise increasing the likelihood of road traffic crashes in the absence of effective interventions. To target drinking and driving in Vietnam we call for a multifaceted approach, including social marketing and public education campaigns, enhanced enforcement, and programs that either limit the number of drinks to drivers or young individuals or those that provide alternatives to drinking and driving.

[Road traffic injuries in developing countries: research and action agenda]. / Traumatismos causados por el tránsito en países en desarrollo: agenda de investigación y de acción.

Road traffic injury (RTI) is the leading cause of death in persons aged 10-24 worldwide and accounts for about 15% of all male deaths. The burden of RTI is unevenly distributed amongst countries with over eighty-fold differences between the highest and lowest death rates. Thus the unequal risk of RTI occurring in the developing world, due to many reasons, including but not limited to rapid motorization and poor infrastructure, is a major global challenge. This editorial highlights a number of key issues that must inform programs designed to prevent RTI in the developing world, where the epidemic is all the more insidious. Firstly, road safety is a development issue; secondly, road traffic injury is a major health issue; thirdly, road traffic injuries can be prevented by the implementation of scientific measures; fourth, pre-hospital and hospital emergency care is needed; and fifth, research on RTI is neglected in low-income and middle-income countries. The repercussion of such progress to Peru is also discussed.

Traumatismos causados por el tránsito en países en desarrollo: agenda de investigación y de acción / Road traffic injuries in developing countries: research and action agenda

Los traumatismos causados por el tránsito son la principal causa de muerte en personas de 10-24 años a nivel mundial y representan alrededor del 15% de todas las muertes en varones. La carga de enfermedad de los traumatismos causados por el tránsito está distribuida de manera desigual entre los países pues la tasa de mortalidad más alta es ochenta veces superior a las más baja. Existe una clara desigualdad en el riesgo de ocurrencia de traumatismos causados por el tránsito, siendo notoriamente mayor en los países en desarrollo. Esta desigualdad se constituye como un reto mundial importante y se debe, aunque no sean los únicos factores, a muchas razones, incluyendo la rápida motorización y la pobre infraestructura. Este artículo hace énfasis en varios aspectos fundamentales cuya finalidad es informar a los programas diseñados para prevenir los traumatismos causados por el tránsito en los países en desarrollo, donde esta situación está más extendida. En primer lugar, la seguridad vial es un tema de desarrollo; en segundo lugar, los traumatismos causados por el tránsito constituyen un problema importante para la salud; en tercer lugar, los traumatismos causados por el tránsito pueden ser prevenidos mediante la implementación de medidas científicas adecuadas; en cuarto lugar, es necesaria la atención de emergencias hospitalarias y prehospitalarias; y, finalmente, la investigación en los traumatismos causados por el tránsito está relegada en los países de ingresos bajos y medios. Se discute además la repercusión de estos avances para el Perú.

Road traffic injury (RTI) is the leading cause of death in persons aged 10-24 worldwide and accounts for about 15 per cent of all male deaths. The burden of RTI is unevenly distributed amongst countries with over eighty-fold differences between the highest and lowest death rates. Thus the unequal risk of RTI occurring in the developing world, due to many reasons, including but not limited to rapid motorization and poor infrastructure, is a major global challenge. This editorial highlights a number of key issues that must inform programs designed to prevent RTI in the developing world, where the epidemicis all the more insidious. Firstly, road safety is a development issue; secondly, road traffic injury is a major health issue; thirdly, road traffic injuries can be prevented by the implementation of scientific measures; fourthly, pre-hospital and hospital emergency care is needed; and fifthly, research on RTI is neglected in low-income and middle-income countries. The repercussion of such progress to Peru is also discussed.