The impact of interventions for preventing injuries and fatalities among motorcyclists in low- and middle-income countries

Washington DC January 12, 2016

THE IMPACT OF INTERVENTIONS FOR

PREVENTING INJURIES AND FATALITIES AMONG

MOTORCYCLISTS IN LOW- AND MIDDLE-INCOME

COUNTRIESResults from Systematic Review: Regulatory and Road Engineering

Interventions for Preventing Road Traffic Injuries and Fatalities among Vulnerable Road Users in Low- and Middle-Income

Countries

The Impact of Interventions for Preventing Injuries and Fatalities among Motorcyclists in Low- and Middle- Income Countries

AGENDA METHODS STUDY RESULTS DATA ANALYSIS OUTLINE OF EVIDENCE CONCLUSION


POPULATION Vulnerable Road Users:- Non-motorised road users: Pedestrians, cyclists, rickshaws etc- Motorised two-wheel road users (motorcycles, mopeds, and light mopeds) of all ages Low- and Middle-income Countries

COMPARATOR Compared changes in outcomes before and after the

intervention with or without a control group


STUDY DESIGN Randomized Control Trials Non-randomized: Uncontrolled before and after,

Controlled before and after, Time series, Controlled cohort, Uncontrolled cohort, and Case control

Road safety audits were considered if a qualifying intervention study met the inclusion criteria

The Impact of Interventions for Preventing Injuries and Fatalities among Motorcyclists in Low- and Middle-Income Countries

INTERVENTIONSPopulation level interventions:

Traffic Law Enforcement & Regulatory Road Engineering

This review did not look at Education, Information and Media Advocacy Vehicle design and Post crash/trauma care


OUTCOMES Mortality measures

- Road traffic death counts/death rates Morbidity measures

- Number of proportion of severe injuries- Number or proportion of moderate injuries- Number or proportion of road traffic accidents

Secondary outcomes- Compliance- Mean vehicular speed- Mean vehicular conflict

The Impact of Interventions for Preventing Injuries and Fatalities among Motorcyclists in Low- and Middle- Income CountriesDescription of Studies

Bastos 2005

Bhatti 2011

Chiu 2000

Ichikawa 2002

Liberatti 2001

Nguyen 2013

Panichaphongse 1995

Espitia-Hardeman 2008

Radin Umar 1995a

Radin Umar 2005

Mulyadi 2013

Radin Umar 1995b

Time Series Uncontrolled Before and After

Road Engi

-neeringC

onspicuity - Use

of Daytim

e Head

-lightM

andatory H

elmet U

se

Study Sample size

Bastos 2005 6298 motorcyclists

Bhatti 2011742 motorcyclists and 295 pillion riders

Chiu 20008795 cases of motorcycle related head injuries

Ichikawa 2002 12,002 injured motorcyclists

Liberatti 2001 1837 motorcycle victims

Nguyen 2013 665,428 motorcycle riders

Panichaphongse 1995

4035 injured motorcycle accidents

Espitia-Hardeman 2008 Not available

Radin Umar 1995a3662 motorcycle accidents

Radin Umar 2005 4319 motorcycle accidents

Mulyadi 2013 4700 vehicles per 30 green lights

Radin Umar 1995b4865 motorcycle accidents

DATA ANALYSIS Traffic Law Enforcement & Regulatory Interventions

Outcome changes without a control group before and afterFatalities among Motorcycle Riders – Mandatory Helmet Use

Fatalities declined by 6%, absence of substantial heterogeneity

DATA ANALYSIS Traffic Law Enforcement & Regulatory Interventions

Outcome changes without a control group before and afterInjuries among Motorcycle Riders – Mandatory Helmet Use

Injuries (moderate and severe) declined by 26%

Traffic Law Enforcement & Regulatory Interventions

Outcome changes without a control group before and afterSevere injuries among Motorcycle Riders – Mandatory Helmet Use

Severe injuries declined by 9%, statistically significant


Outcome changes without a control group before and afterCompliance among Motorcycle Riders – Mandatory Helmet Use

Compliance to mandatory helmet enforcement resulted in eight time more compliance. Statistically significant presence of heterogeneity


Outcome changes in time series before and afterRoad Traffic Accidents among Motorcycle Riders – Day time Running Headlights

The number of accidents declined post intervention period. Mean percent change in accident declined by 38%. A study Espitia-Hardeman 2008 reported fatalities, Log RR -1.79 (CI -2.60, -0.98). Percent change in accidents -500.65 (CI -1248.43, -165.55)

51%

62%

68%

DATA ANALYSIS Road Engineering Interventions

Effect of Exclusive Motorcycle Lanes Intervention A time-series study, Radin Umar 1995b analysed

motorcycle accident outcomes Road traffic accidents declined by 11%, percent change

-111.80 (CI -492.9, 24.34)Effect of Red Motorcycle Box at Intersection Intervention

A before and after study, Mulyadi 2013 analysed traffic-conflicts and traffic flow at intersections

Traffic conflicts (per 1000 vehicle) declined marginally, standard mean difference -0.23 (CI -0.32, -0.15)

Traffic volume (pce/green light) increased marginally, standard mean difference 0.30 (CI 0.25, 0.35)


OUTLINE OF EVIDENCETraffic Law Enforcement & Regulatory Interventions Road traffic crashes resulting in fatalities declined by 6% Road traffic injuries resulting in injuries declined by 26% Mandatory helmet law enforcement resulted in eighth

times more compliance among motorcyclists. Conspicuity related road accidents dropped by 38%Road Engineering Interventions In percent change, accidents declined by 11% as a result

of exclusive motorcycle lanes


CONCLUSION AND RECOMMENDATIONS The effect of interventions being implemented

by LMICs demonstrate the initial stages of positive developments

Stringent enforcement of traffic laws & regulatory interventions

In road engineering, segregation of motorcycle riders from motorised vehicles can potentially reduce traffic conflicts

Improved injury surveillance systems on road traffic injuries are required


The protocol is registered with the Cochrane Public Health Group and published in Cochrane Liberary

The Systematic Review is funded by the Department for International Development

Washington DC January 12, 2016

Healthcare

The impact of interventions for preventing injuries and fatalities among motorcyclists in low- and middle-income countries