The neglected epidemic: road traffic injuries in Kenya

Motorized road transport has changed the face of employment, trade, family life and health care, bringing benefits that were unimaginable 100 years ago. We can now get patients to emergency rooms, deliver relief at the sites of disasters and take holidays in places we would not have been able to visit before. However, the price we are paying for such benefits is too high.

At the inquest into the world’s first road traffic death in 1896, the coroner was reported to have said “this must never happen again”. More than a century later, 1.2 million people are killed on roads every year and up to 50 million more are injured. These casualties of the road will increase unless safety is made a priority.

Roads are bustling with cars, buses, trucks, motorcycles, mopeds and other types of two- and three-wheelers. By making the transportation of goods and people faster and more efficient, these vehicles support economic and social development in many countries. A recent addition the mobile phone has further added the risk due to use while driving or crossing roads. Pedestrians and cyclists using roads are particularly at risk. Crashes are frequent. Deaths and injuries are common.

If current trends continue, the number of people killed and injured on the roads will rise by more than 60% between 2000 and 2020.

During the course of any day, the tragic news of a death on the road is delivered about 20 times to families and friends. One hundred times, people will hear that one of their family members has survived a crash but with serious injury and perhaps lifelong disability. The shock and grief these events cause are all too well-known throughout the world

A variety of approaches are being used to tackle some of the causes, including better legislation, enforcement and information. A number of initiatives, show that improving road safety is possible.

Kenya needs to designate a lead agency in government which can coordinate the national road safety efforts. There is also need to assess the problem, prepare a national road safety strategy, allocate financial and human resources, and implement specific interventions that are known to work. These include setting and enforcing laws on seat-belts, child restraints, helmets and drink driving; regulated use of cell phones; and promoting daytime running lights and improved visibility of all road users.

In addition to setting laws and raising awareness, there is need to formulate policies that promote safer vehicles, safer traffic management and safer road design. The countries that have been most successful have been those that have engaged many different groups from government, civil society and industry in a coordinated programme of road safety.

Every sector is important - transport, education, health, law enforcement - in tackling the problem. The public health community needs to increase its contribution. By strengthening emergency services for victims, improving data collection, contributing to policies, developing prevention activities or simply ringing the alarm bell - as we are doing today - we can all make significant contributions.

Everyone can increase road safety in their private capacity as well - as drivers, passengers and pedestrians, and as members of the public who influence decision-makers. Road deaths and injuries are preventable. Let us use all means to draw attention to this fact.

Road traffic injuries particularly affect the productive (working) age group (15-44 years) and children. The problem is increasing at a fast rate in due to rapid motorization and other factors. However, public policy responses to this epidemic have been muted at national and international levels. Policy makers need to recognize this growing problem as a public health crisis and design appropriate policy responses.

People are frequently aware of these risks. A regular commuter on the buses to Nyanza-said, “Many of us know most of the buses are death traps but since we have no alternative we have no choice but to use the buses.”

Reasons for high burden in KenyaGrowth in motor vehicle numbersThe growth in numbers of motor vehicles is a major contributing factor in the rising toll of fatalities and injuries from road traffic crashes.Poor enforcement of traffic safety regulations

Another explanation for the high burden is poor enforcement of traffic safety regulations in low-income countries due to inadequate resources, administrative problems, and corruption. Corruption is a huge problem, often creating a circle of blame---the police blame drivers and the public, the public blames drivers and the police, and drivers blame the police. Corruption also extends to vehicle and driver licensing agencies. An officer with Traffic department said, “You wonder how most of the buses/matatus secured road worthiness certificates in the first place. And when you ban the buses from the roads, they still find their way of returning to the roads.”

Inadequacy of public health infrastructure and poor access to health services

Another explanation is the inadequacy of the public health infrastructure in providing treatment for traffic injuries. Only 40% of public, mission, and private hospitals in Kenya in 1999 were well prepared to treat trauma cases from traffic crashes, with 74% of the least injuries. The poor public health infrastructure means that patients often do not receive appropriate care promptly. This delay can compromise the patient's recovery, as there is a strong correlation between the time taken to receive appropriate treatment and the likelihood of adverse health outcomes and long term disability occurring.

Addressing the risks will require multiple policy initiatives. To be effective, policies on traffic safety must be based on local evidence and research, and designed for the particular social, political, and economic circumstances.

Sidebar

Five Key areas of Intervention

1. SpeedSpeed: slow down!Speed contributes to at least 30% of road traffic crashes and deaths.For every 1km/hr increase in speed there is a 3% increase in the incidence of injury crashes and a 5% increase in the risk of a fatal crash.Pedestrians are eight times more likely to be killed by cars traveling at 50km/h than 30km/h.Key interventionssetting and enforcing speed limitsdesigning roads according to their function (e.g. highways, suburban roads)speed cameras or stationary enforcementtraffic calming measures, such as speed bumps and traffic circleseducation and public information.

2. Alcohol:Alcohol: don't drink alcohol and driveFactsAny level of alcohol in the blood increases the risk of crashes.The risk of crashes increases significantly with blood alcohol concentrations greater than 0.04g/dl.Key interventionssetting and enforcing blood alcohol concentration limitsrandom breath testingmass media campaignstough and swift penalties for offendersbreath test devices as ignition interlocks in vehicles.

3.Seat Belts:Seat-belts and child restraints: strap in!

Facts

Seat-belt usage has saved more lives than any other road safety intervention.Seat-belts reduce fatal or serious injury by 40-65%.Child restraints reduce infant deaths by 71% and deaths in young children by 54%.Key interventionssetting and enforcing seat-belt use and child restraint lawspublicity campaignssmart, audible seat belt reminders (e.g. alarm sounds in vehicles)child restraint loan programmes.

4. Helmets:Wear helmets!FactsHead trauma is the main cause of death and disability in drivers of motorized two-wheelers.Among children, bicycle injuries are the leading cause of injury.Key interventionssetting and enforcing laws on helmet wearingstandards for motorcycle helmetspenalties for non-usetargeted information campaigns.Example: Helmet use in ThailandIn the year following enforcement of the helmet-wearing law in Thailand, helmet use increased five-fold, head injuries decreased by 41%, and deaths decreased by 20%.

5. Visibility:Visibility: see and be seenFactsMotorized vehicles using daytime running lights have a crash rate 10-15% lower than those that do not.One third of people hit on the road report they had difficulty seeing the vehicle; almost half of drivers have difficulty in seeing the pedestrian.Key interventionsDaytime running lights for two-wheelers and carsReflectors on vehicles and reflective clothing for peopleWhite/yellow helmetsStreet lighting.

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